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Prevalence and predictors of coronary artery disease in patients with a calcium score of zero

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Abstract

The absence of coronary calcification is associated with an excellent prognosis. However, a calcium score of zero does not exclude the presence of coronary artery disease (CAD) or the possibility of future cardiovascular events. Our aim was to study the prevalence and predictors of coronary artery disease in patients with a calcium score of zero. Prospective registry consisted of 3,012 consecutive patients that underwent cardiac CT (dual source CT). Stable patients referred for evaluation of possible CAD that had a calcium score of zero (n = 864) were selected for this analysis. The variables that were statistically significant were included in a multivariable logistic regression model. From 864 patients with a calcium score of zero, 107 (12.4 %) had coronary plaques on the contrast CT (10.8 %, n = 93 with nonobstructive CAD and 1.6 %, n = 14 with obstructive CAD). By logistic regression analysis, the independent predictors of CAD in this population were age >55 years [odds ratio (OR) 1.63 (1.05–2.52)], hypertension [OR 1.64 (1.05–2.56)] and dyslipidemia [OR 1.54 (1.00–2.36)]. In the presence of these 3 variables, the probability of having coronary plaques was 21 %. The absence of coronary artery calcification does not exclude the presence of coronary artery disease, but the prevalence of obstructive disease is very low. In this population, the independent predictors of CAD in the setting of a calcium score of zero were hypertension, dyslipidemia, and age above 55 years. In the presence of these 3 predictors, the probability of having CAD was almost 2 times higher than in the general population.

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References

  1. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K et al (2009) Heart disease and stroke statistics—2009 update: a report from the American heart association statistics committee and stroke statistics subcommittee. Circulation 119(3):480–486

    Article  PubMed  Google Scholar 

  2. Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr et al (1995) A definition of advanced types of atherosclerotic lesions, a histological classification of atherosclerosis. A report from the committee on vascular lesions of the council on arteriosclerosis, American heart association. Arterioscler Thromb Vasc Biol 15:1512–1531

    Article  PubMed  CAS  Google Scholar 

  3. Budoff M, Jollis JG, Dowe D, Min J for the VCT study group (2013) Diagnostic accuracy of coronary artery calcium for obstructive disease: results from the ACCURACY trial. Int J Cardiol 166(2):505–508

    Google Scholar 

  4. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR et al (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358:1336–1345

    Article  PubMed  CAS  Google Scholar 

  5. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O’Leary D et al (2012) Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA 308:788–795

    Article  PubMed  CAS  Google Scholar 

  6. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228(3):826–833

    Article  PubMed  Google Scholar 

  7. Petretta M, Daniele S, Acampa W, Imbriaco M, Pellegrino T, Messalli G et al (2012) Prognostic value of coronary artery calcium score and coronary CT angiography in patients with intermediate risk of coronary artery disease. Int J Cardiovasc Imaging 28(6):1547–1556

    Article  PubMed  Google Scholar 

  8. Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Cury RC et al (2009) Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Imaging 2:675–688

    Article  Google Scholar 

  9. National Institute for Health and Clinical Excellence (2010) Chest pain of recent onset. Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. London: NICE. Available from: http://www.nice.org.uk/guidance/CG95

  10. Haberl R, Tittus J, Böhme E, Czernik A, Richartz BM, Buck J et al (2005) Multislice spiral computed tomographic angiography of coronary arteries in patients with suspected coronary artery disease: an effective filter before catheter angiography? Am Heart J 149:1112–1119

    Article  PubMed  Google Scholar 

  11. Akram K, O’Donnell RE, King S, Superko HR, Agatston A, Voros S (2009) Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score. Atherosclerosis 203:533–537

    Article  PubMed  CAS  Google Scholar 

  12. Gottlieb I, Miller JM, Arbab-Zadeh A, Dewey M, Clouse ME, Sara L et al (2009) The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol 44:627–634

    Google Scholar 

  13. Rubinshtein R, Gaspar T, Halon DA, Goldstein J, Peled N, Lewis BS (2007) Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome. Am J Cardiol 99:472–475

    Article  PubMed  Google Scholar 

  14. Nieman K, Galema TW, Neefjes LA, Weustink AC, Musters P, Moelker AD et al (2009) Comparison of the value of coronary calcium detection to computed tomographic angiography and exercise testing in patients with chest pain. Am J Cardiol 104(11):1499–1504

    Article  PubMed  CAS  Google Scholar 

  15. van Werkhoven J, de Boer S, Schuijf J, Cademartiri F, Maffei E, Jukema J et al (2010) Impact of clinical presentation and pretest likelihood on the relation between calcium score and computed tomographic coronary angiography. Am J Cardiol 106(12):1675–1679

    Article  PubMed  Google Scholar 

  16. Villines TC, Hulten EA, Shaw LJ, Goyal M, Dunning A, Achenbach S et al (2011) Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (coronary CT angiography evaluation for clinical outcomes: an international multicenter) registry. J Am Coll Cardiol 58:2533–2540

    Article  PubMed  Google Scholar 

  17. Gavin J, Alberti K, Davidson M, DeFronzo R, Drash A, Gabbe S et al (1997) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabet Care 20(7):1183–1197

    Google Scholar 

  18. Grundy S, Becker D, Clark L, Cooper R, Denke M, Howard W et al Expert panel on detection evaluation and treatment of high blood cholesterol in adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285(19):2486–2497

    Google Scholar 

  19. European Society of Hypertension-European Society of Cardiology Guidelines C (2003) European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension (2003). J Hypertens 21(6):1011–1053

    Article  Google Scholar 

  20. Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG (2005) Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean 3-year outcomes in 18 the prospective army coronary calcium (PACC) project. J Am Coll Cardiol 46(5):807–814

    Article  PubMed  CAS  Google Scholar 

  21. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF et al (2002) American college of cardiology/American heart association task force on practice guidelines (committee to update the 1997 exercise testing guidelines). ACC/AHA, guideline update for exercise testing: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines. Circulation 106(14):1883–1892

    Article  PubMed  Google Scholar 

  22. Morise AP, Haddad WJ, Beckner D (1997) Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am J Med 102(4):350–356

    Article  PubMed  CAS  Google Scholar 

  23. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M et al (2012) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint Task Force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts) Developed with the special contribution of the European association for cardiovascular prevention and rehabilitation (EACPR). Eur Heart J 33(13):1635–1701

    Article  PubMed  CAS  Google Scholar 

  24. Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ et al (2007) Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 50(12):1161–1170

    Article  PubMed  Google Scholar 

  25. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. Circulation 92:2157–2162

    Article  PubMed  CAS  Google Scholar 

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All the authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal

    Maria Salomé Leal de Carvalho, Pedro de Araújo Gonçalves, Pedro Jerónimo de Sousa, Helder Dores, Ana Aleixo & Miguel Mendes

  2. Hospital da Luz, Lisboa, Portugal

    Pedro de Araújo Gonçalves, António Ferreira, Nuno Cardim, Francisco Pereira Machado, José Roquette & Hugo Marques

  3. Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands

    Hector M. Garcia-Garcia

  4. CEDOC – Chronic Diseases Research Center – FCM-Nova, Lisboa, Portugal

    Pedro de Araújo Gonçalves, Miguel Mota Carmo & Ana Aleixo

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  1. Maria Salomé Leal de Carvalho
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  2. Pedro de Araújo Gonçalves
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Correspondence to Maria Salomé Leal de Carvalho.

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de Carvalho, M.S.L., de Araújo Gonçalves, P., Garcia-Garcia, H.M. et al. Prevalence and predictors of coronary artery disease in patients with a calcium score of zero. Int J Cardiovasc Imaging 29, 1839–1846 (2013). https://doi.org/10.1007/s10554-013-0267-x

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  • DOI: https://doi.org/10.1007/s10554-013-0267-x

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