Interplay Between Zero CAC, Quantitative Plaque Analysis, and Adverse Events in a Diverse Patient Cohort

Area of Science:

• Cardiology
• Radiology
• Preventive Medicine

Background:

• Coronary artery calcium (CAC) scoring is used for chest pain evaluation.
• Limited data exists on zero CAC in relation to patient demographics and plaque characteristics.

Purpose of the Study:

• To investigate the association between zero CAC, sex, race, ethnicity, and quantitative coronary plaque analysis.
• To assess the negative predictive value of zero CAC across different demographic groups.

Main Methods:

• Retrospective analysis of patients undergoing coronary computed tomography angiography.
• Inclusion criteria: stable angina, no prior myocardial infarction or revascularization.
• Follow-up endpoints included invasive angiography, myocardial infarction, revascularization, and death.

Main Results:

• 2249 patients included; 55% had zero CAC.
• Zero CAC had high negative predictive value for plaque, stenosis, and adverse events.
• No significant differences in zero CAC's negative predictive value by sex, race, or ethnicity.
• 7% of zero CAC patients had noncalcified plaque; higher prevalence in those with ≥2 risk factors.

Conclusions:

• The negative predictive value of zero CAC is consistent across diverse demographics.
• Patients with zero CAC and multiple risk factors show a higher prevalence of noncalcified plaque.
• Caution is advised when reducing preventive treatment in zero CAC patients presenting with chest pain and multiple risk factors.