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The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain: A Meta-Analysis

Ali M Agha1, Justin Pacor2, Gowtham R Grandhi3

  • 1Baylor College of Medicine, Houston, Texas, USA.

JACC. Cardiovascular Imaging
|October 6, 2022
PubMed

Insights

Absence of coronary artery calcium (CAC) in patients with chest pain effectively rules out obstructive coronary artery disease (CAD). A CAC score of zero indicates a very low risk of major adverse cardiac events, supporting its use in guiding further testing.

Area of Science:

  • Cardiology
  • Radiology
  • Preventive Medicine

Background:

  • Limited consensus exists on using coronary artery calcium (CAC) absence to safely defer further testing in patients with chest pain (CP).
  • Evaluating the utility of CAC assessment is crucial for managing patients with suspected coronary artery disease (CAD).

Purpose of the Study:

  • To systematically review and meta-analyze the effectiveness of CAC assessment in ruling out obstructive CAD.
  • To investigate CAC's role in patients with stable and acute CP at low-to-intermediate risk undergoing coronary computed tomography angiography (CTA).

Main Methods:

  • Systematic review and meta-analysis of studies published between 2005 and 2021.
  • Included studies examined the relationship between CAC and obstructive CAD (≥50% narrowing) on coronary CTA.
  • Analyzed data from 19 papers (79,903 patients) with stable CP and 13 papers (12,376 patients) with acute CP.

Main Results:

  • A CAC score of 0 was found in 45% of stable CP and 58% of acute CP patients.
  • The negative predictive value of CAC=0 for obstructive CAD was high (97% for stable, 98% for acute CP).
  • CAC=0 was associated with low prevalence of nonobstructive CAD and low rates of major adverse cardiac events (0.5%-0.8%).

Conclusions:

  • Absence of CAC in over 92,000 patients strongly correlates with a very low prevalence of obstructive and nonobstructive CAD.
  • A zero CAC score is linked to a low annualized risk of major adverse cardiac events.
  • CAC=0 can serve as a "gatekeeper" to potentially avoid unnecessary advanced imaging in CP patients within value-based care models.
Abstract

Keywords:
atherosclerosischest paincoronary artery calciumcoronary computed tomography angiography

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