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Prevalence of coronary artery disease in symptomatic patients with zero coronary artery calcium score in different age population

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Abstract

There is controversy about whether symptomatic population with coronary artery calcium score (CACS) of zero have coronary artery disease (CAD) and the distribution at different ages. We sought to analyze the prevalence of CAD in symptomatic patients with zero CACS, especially in different age groups. We studied patients suspected of CAD and underwent CACS scan and coronary computed tomography angiography (CTA). We included patients with CACS of zero. Clinical data was collected to achieve information on demographic characteristics and risk factors. The presence of plaque and obstructive CAD were analyzed based on coronary CTA. The association between age and the prevalence of plaque and obstructive CAD was evaluated.Overall 5514 patients (51.1% men; mean age 54.40 years) were analyzed, of whom 4120 (74.72%) with normal coronary artery, 1394 (25.28%) with plaque and 514 (9.32%) with obstructive CAD. The prevalence of plaque and obstructive CAD increased significantly with age (p < 0.001). Age was significantly associated with the risk of developing plaque and obstructive CAD in the unadjusted model and multivariate model. Taking age less than 40 as a reference, risk ratios (RRs) of prevalence of plaque increased with age in the multivariate model (RR = 2.353 for 40–50, RR = 6.489 for > 70). RRs of prevalence of obstructive CAD also increased with age in the multivariate model (RR = 2.075 for 40–50, RR = 4.102 for > 70). Quite a few CAD could occur in symptomatic patients with CACS of zero, especially in old patients. Coronary CTA was required to exclude CAD in this cohort.

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Funding

This study is supported by a grant (2016YFC1300400) from the Ministry of Science and Technology of China, National key research and development project.

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Authors and Affiliations

  1. Department of Radiologic Imaging, Fu Wai Hospital, State Key Lab and National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, #167 Bei-Li-Shi Street, Xi-Cheng District, 100037, Beijing, People’s Republic of China

    Yi-tong Yu, Zhi-hui Hou, Bin Lu, Yun-qiang An, Yang Gao, Wei-hua Yin & Xin-shuang Ren

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  1. Yi-tong Yu
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  2. Zhi-hui Hou
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  3. Bin Lu
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  4. Yun-qiang An
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  5. Yang Gao
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  6. Wei-hua Yin
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  7. Xin-shuang Ren
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by YY, ZH and BL. The first draft of the manuscript was written by YY and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript. All authors have made important contributions to the study and are thoroughly familiar and can warrant their contribution to the editor.

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Correspondence to Bin Lu.

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The authors declare that they have no conflict of interest.

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This retrospective cohort study was approved by the Institutional Review Board and the need for informed consent was waived.

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Yu, Yt., Hou, Zh., Lu, B. et al. Prevalence of coronary artery disease in symptomatic patients with zero coronary artery calcium score in different age population. Int J Cardiovasc Imaging 37, 723–729 (2021). https://doi.org/10.1007/s10554-020-02028-8

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  • DOI: https://doi.org/10.1007/s10554-020-02028-8

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