title: Meaning of zero coronary calcium score in symptomatic patients referred for coronary computed tomographic angiography.
abstract: OBJECTIVE
  The clinical implication of a zero coronary calcium score (CCS) in patients with chest pain syndrome has been under debate. This study was undertaken to determine the meaning of a CCS of zero in a large sample of symptomatic patients referred for coronary computed tomographic (CT) angiography.
  
  
  RESULTS
  We consecutively enrolled 2088 patients (age 58 ± 10 years, 1028 men) who had undergone 64-slice cardiac CT due to chest pain syndrome. A CCS of zero was detected in 1114 patients (471 men and 643 women). Of these 1114 patients, obstructive coronary artery disease (CAD) was found in a total of 48 patients (4.3%); 35 men (7.4%) and 13 women (2.0%). Among the zero CCS patients with obstructive CAD, men had a higher prevalence of both premature CAD (49 vs. 0%) and multivessel disease (20 vs. 8%) than women. During the follow-up period (1033 ± 136 days), early revascularization was done in 25 patients (2.2%, 18 men and 7 women) and there were 14 major adverse cardiac events (1.3%, 8 men and 7 women) among the zero CCS patients. CAD severity was a strong prognostic indicator in the zero CCS patients.
  
  
  CONCLUSIONS
  A CCS of zero cannot be used by itself to exclude obstructive CAD in symptomatic patients referred for coronary CT angiography (CCTA). The prevalence of obstructive CAD and adverse cardiac events are not negligible in symptomatic patients with a CCS of zero, and CAD severity by CCTA is associated with higher rates of adverse cardiac event.
authors.affiliation: Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul,  Republic of Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jin
authors.initials: J
authors.lastname: Hur
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Nam
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Hong
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging*; D055424:Cardiac-Gated Imaging Techniques; D002637:Chest Pain / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007479:Iopamidol