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Does Sex or Age Impact the Prognostic Value of a Zero Coronary Artery Calcium Score?
Jeffrey L Anderson1,2, Dave S Collingridge1, Viet T Le1,3
1Intermountain Heart Institute, Intermountain Health, Salt Lake City, UT 84107, USA.
Insights
A zero coronary artery calcium (CAC) score indicates an excellent prognosis for coronary events and all-cause mortality. This finding holds true across different age groups and for both women and men.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- The prognostic significance of a zero coronary artery calcium (CAC) score in relation to sex and age remains unclear.
- Evaluating the impact of demographic factors on the predictive value of CAC scores is crucial for personalized risk assessment.
Purpose of the Study:
- To determine if sex and age influence the prognostic value of a zero CAC score for coronary events and all-cause mortality.
- To assess the long-term outcomes associated with zero CAC scores in diverse patient populations.
Main Methods:
- Retrospective analysis of electronic medical records for primary prevention patients who underwent PET/CT stress testing.
- Comparison of coronary prognosis and all-cause death rates between patients with CAC = 0 and CAC > 0 scores.
- Stratification of outcomes by sex (women vs. men) and age (≥65 vs. <65 years).
Main Results:
- A total of 40,018 patients were analyzed, with 19.9% having a CAC score of 0.
- In patients with CAC = 0, coronary events were rare (0.13% in women, 0.24% in men; 0.12% in <65, 0.25% in ≥65).
- All-cause mortality was significantly lower in patients with CAC = 0 compared to CAC > 0 across all subgroups (p < 0.001).
Conclusions:
- A zero CAC score is a strong predictor of excellent prognosis for both coronary events and all-cause mortality.
- The favorable prognostic value of a zero CAC score is consistent across different age groups and sexes.
- Zero CAC scores provide valuable risk stratification information for primary prevention patients.
Abstract:
Background: It is unclear whether sex or age impacts the prognostic value of a zero coronary artery calcium (CAC) score. Methods: We searched our electronic medical record (eMR) database for primary prevention patients who underwent positron emission tomography/computed tomography (PET/CT) stress testing. We assessed coronary prognosis and all-cause death during 2.2 (SD 1.9) years of follow-up in women vs. men and in those ≥65 vs. <65 years old by CAC = 0 vs. CAC > 0 scores. Results: We identified 40,018 qualifying patients, of which 48.7% were women and 58.9% were ≥65. CAC = 0 was present in 7967 (19.9%), of which 67.8% were women, and 34.9% were aged ≥65. In CAC = 0 patients, 13 coronary events occurred: 7 (0.13%) in women and 6 (0.24%) in men (p = 0.28); and 6 (0.12%) in <65 and 7 (0.25%) in ≥65 years old (p = 0.15). All-cause death rates comparing CAC = 0 to CAC > 0 subjects were 3.1% vs. 9.8% overall: 3.1% vs. 9.5% in women and 3.3% vs. 10.2% in men, 2.4% vs. 6.9% for ages <65, and 4.7% vs. 11.5% for ≥65 years old; all p < 0.001. Conclusions: A zero CAC score predicts an excellent prognosis for not only coronary events but also all-cause mortality, both overall and in women and the elderly.
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