title: Independent prognostic value of coronary artery calcium score and coronary computed tomography angiography in an outpatient cohort of low to intermediate risk chest pain patients.
abstract: BACKGROUND
  Limited studies report on the additional prognostic value of coronary computed tomography angiography (CCTA) and the coronary artery calcium score (CACS).
  
  
  METHODS
  For a median of 637 days, 1551 outpatients with chest pain, without known coronary artery disease (CAD) and low or intermediate pre-test probability of CAD, were followed for major adverse cardiac events (MACE), defined as death, myocardial infarction or late revascularisation. Cox proportional hazard regression was used to evaluate the independent prognostic value of CCTA and CACS.
  
  
  RESULTS
  MACE occurred in 23 patients (1.5 %): death (3, 0.2 %), myocardial infarction (4, 0.3 %) and late revascularisation (16, 1.3 %). Multivariate analysis showed an independent prognostic value of CCTA (p < 0.001), CACS of 100-400 (p = 0.035) and CACS of > 400 (p = 0.021). CCTA showed obstructive CAD in 3.1 % of patients with CACS = 0. No events occurred in patients with CACS = 0 without obstructive CAD at CCTA, whereas 2/23 patients (9 %) with CACS = 0 with obstructive CAD had a MACE.
  
  
  CONCLUSIONS
  Our study shows that both CCTA and higher CACS categories have independent prognostic value in chest pain patients with low to intermediate pre-test probability of obstructive CAD, in which CCTA is appropriate. Furthermore a non-negligible amount of patients with CACS = 0 have obstructive CAD at CCTA. CCTA can be used in these patients to identify those at risk for MACE.
authors.affiliation: Department of Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands. bommichiel@gmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bom
authors.affiliation: Department of Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Van der Zee
authors.affiliation: Department of Nuclear Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: F M
authors.initials: FM
authors.lastname: Van der Zant
authors.affiliation: Department of Nuclear Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: R J J
authors.initials: RJ
authors.lastname: Knol
authors.affiliation: Department of Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Cornel
keywords: CACS; CCTA; Coronary artery calcium; Coronary computed tomography angiography; MACE; Prognosis