Diagnostic and prognostic value of absence of coronary artery calcification.
OBJECTIVE
In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals.


BACKGROUND
Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes. Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events.


METHODS
We searched online databases (e.g., PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC.


RESULTS
A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion. These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients. In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months. In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 1.80% of patients without CAC had a cardiovascular event. Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography. In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia. Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome.


CONCLUSIONS
On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group.
Sarwar
Ammar
A
Cardiac PET CT MRI Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Shaw
Leslee J
LJ
Shapiro
Michael D
MD
Blankstein
Ron
R
Hoffmann
Udo
U
Hoffman
Udo
U
Cury
Ricardo C
RC
Abbara
Suhny
S
Brady
Thomas J
TJ
Budoff
Matthew J
MJ
Blumenthal
Roger S
RS
Nasir
Khurram
K
D054058:Acute Coronary Syndrome / Q000150:complications; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed