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Influence of Age on the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Obstructive Coronary Disease

Francisco Albuquerque1, Pedro M Lopes1, Pedro Freitas1

  • 1Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.

The American Journal of Cardiology
|August 16, 2023
PubMed

Insights

A zero coronary artery calcium score (CACS) is valuable for ruling out obstructive coronary artery disease (CAD) in symptomatic patients, regardless of age. While its diagnostic value decreases in younger individuals, high negative predictive values remain consistent across all age groups.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Accuracy

Background:

  • Coronary artery calcium score (CACS) is used to assess coronary artery disease (CAD) risk.
  • The diagnostic utility of a CACS of 0 in younger, symptomatic patients requires further clarification.

Purpose of the Study:

  • To evaluate the influence of age on the diagnostic value of a CACS of 0 in symptomatic patients with suspected obstructive CAD.
  • To determine the negative predictive value of a CACS of 0 across different age groups.

Main Methods:

  • Retrospective analysis of 2,043 symptomatic patients who underwent CACS and coronary computed tomography angiography (CCTA).
  • Calculation of pretest probability using the Juarez-Orozco method.
  • Assessment of diagnostic likelihood ratios and negative predictive values for a CACS of 0.

Main Results:

  • The prevalence of obstructive CAD and the proportion of patients with CACS of 0 varied with age.
  • The added diagnostic value of a CACS of 0 was lower in younger patients (negative likelihood ratios 0.36 for <50 years to 0.10 for ≥70 years).
  • Despite lower diagnostic value in younger groups, the prevalence of obstructive CAD was low in all patients with CACS of 0, resulting in high negative predictive values.

Conclusions:

  • A CACS of 0 demonstrates high negative predictive value for obstructive CAD in symptomatic patients across all age groups.
  • While the added diagnostic value of a CACS of 0 decreases with younger age, it remains a reliable indicator for ruling out obstructive CAD due to low pretest probabilities.

Keywords:
agecoronary artery calcium scorecoronary artery diseasecoronary computed tomography angiography

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