Related Experiment Video
Updated: Jul 19, 2025
Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Interplay Between Zero CAC, Quantitative Plaque Analysis, and Adverse Events in a Diverse Patient Cohort
Michael Fattouh1, Toshiki Kuno1, Pamela Pina1
1Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Insights
Zero coronary artery calcium (CAC) has a high negative predictive value for coronary artery disease, regardless of sex, race, or ethnicity. However, patients with zero CAC and multiple risk factors may still have noncalcified plaque, warranting caution in treatment decisions.
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.
Background:
Coronary artery calcium scoring (CAC) has garnered attention in the diagnostic approach to chest pain patients. However, little is known about the interplay between zero CAC, sex, race, ethnicity, and quantitative coronary plaque analysis.
Methods:
We conducted a retrospective analysis from our computed tomography registry of patients with stable angina without prior myocardial infarction or revascularization undergoing coronary computed tomography angiography at Montefiore Healthcare System. Follow-up end points collected included invasive angiography, type-1 myocardial infarction, coronary revascularization, cardiovascular and all-cause death.
Results:
A total of 2249 patients were included (66% female). The median follow-up was 5.5 years. The median age of those without CAC was 52 years (interquartile range, 44-59) and 60 years (interquartile range, 53-68) in those with CAC. Most patients were Hispanic (58%), and the rest were non-Hispanic Black (28%), non-Hispanic White (10%), and non-Hispanic Asian (5%). The majority had CAC=0 (55%). The negative predictive value of CAC=0 was 92.8%, 99.9%, and 99.9% for any plaque, obstructive coronary artery stenosis, and the composite outcome of all-cause death, myocardial infarction, or coronary revascularization, respectively. Among patients without CAC (n=1237), 89 patients (7%) had evidence of plaque on their coronary computed tomography angiography with a median low-attenuation noncalcified plaque burden of 4% (2-7). There were no significant differences in the negative predictive value for CAC=0 by sex, race, or ethnicity. Patients with ≥2 risk factors had higher odds of having plaque with zero CAC.
Conclusions:
In summary, no sex, race, or ethnicity differences were demonstrated in the negative predictive value of a zero CAC; however, patients with ≥2 risk factors had a higher prevalence of plaque. A small percentage (7%) of symptomatic patients undergoing coronary computed tomography angiography with zero CAC had noncalcified coronary plaque, with the implication that caution is needed for downscaling of preventive treatment in patients with zero CAC, chest pain, and multiple risk factors.
More Related Videos
13:07Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
10:02Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT
Published on: May 2, 2012
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...