title: Prevalence and predictors of coronary artery disease in patients with a calcium score of zero.
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.
authors.affiliation: Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal, mariasalomecarvalho@gmail.com.
authors.forename: Maria Salomé Leal
authors.initials: MS
authors.lastname: de Carvalho
authors.forename: Pedro
authors.initials: P
authors.lastname: de Araújo Gonçalves
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Pedro Jerónimo
authors.initials: PJ
authors.lastname: de Sousa
authors.forename: Helder
authors.initials: H
authors.lastname: Dores
authors.forename: António
authors.initials: A
authors.lastname: Ferreira
authors.forename: Nuno
authors.initials: N
authors.lastname: Cardim
authors.forename: Miguel Mota
authors.initials: MM
authors.lastname: Carmo
authors.forename: Ana
authors.initials: A
authors.lastname: Aleixo
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
authors.forename: Francisco Pereira
authors.initials: FP
authors.lastname: Machado
authors.forename: José
authors.initials: J
authors.lastname: Roquette
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
mesh_terms: D000328:Adult; D000367:Age Factors; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*