TY - JOUR
T1 - The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain
T2 - A Meta-Analysis
AU - Agha, Ali M.
AU - Pacor, Justin
AU - Grandhi, Gowtham R.
AU - Mszar, Reed
AU - Khan, Safi U.
AU - Parikh, Roosha
AU - Agrawal, Tanushree
AU - Burt, Jeremy
AU - Blankstein, Ron
AU - Blaha, Michael J.
AU - Shaw, Leslee J.
AU - Al-Mallah, Mouaz H.
AU - Brackett, Alexandria
AU - Cainzos-Achirica, Miguel
AU - Miller, Edward J.
AU - Nasir, Khurram
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/10
Y1 - 2022/10
N2 - Background: There is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing. Objectives: The purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA). Methods: The authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP. Results: In this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate). Conclusions: Among over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a “gatekeeper” for more advanced imaging among patients presenting with CP.
AB - Background: There is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing. Objectives: The purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA). Methods: The authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP. Results: In this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate). Conclusions: Among over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a “gatekeeper” for more advanced imaging among patients presenting with CP.
KW - atherosclerosis
KW - chest pain
KW - coronary artery calcium
KW - coronary computed tomography angiography
KW - Predictive Value of Tests
KW - Prognosis
KW - Calcium
KW - Risk Assessment
KW - Humans
KW - Risk Factors
KW - Chest Pain/diagnostic imaging
KW - Coronary Artery Disease/complications
KW - Coronary Angiography/methods
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U2 - 10.1016/j.jcmg.2022.03.031
DO - 10.1016/j.jcmg.2022.03.031
M3 - Article
C2 - 36202453
AN - SCOPUS:85138353867
SN - 1936-878X
VL - 15
SP - 1745
EP - 1757
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 10
ER -