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Open AccessJournal ArticleDOI

Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification

TLDR
It is concluded 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.
Abstract
Objectives 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 (eg, 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 (056%) 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, 180% 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

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Journal ArticleDOI

Quantification of coronary artery calcium using ultrafast computed tomography

TL;DR: In this article, the authors used ultrafast computed tomography (UCT) to detect and quantify coronary artery calcium levels in 584 subjects (mean age 48 +/- 10 years) with and without clinical coronary artery disease.
Journal ArticleDOI

Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals

TL;DR: Data support the hypothesis that high CACS can modify predicted risk obtained from FRS alone, especially among patients in the intermediate-risk category in whom clinical decision making is most uncertain.
Journal ArticleDOI

Coronary Artery Calcium Area by Electron-Beam Computed Tomography and Coronary Atherosclerotic Plaque Area A Histopathologic Correlative Study

TL;DR: This histopathologic study confirms an intimate relation between whole heart, coronary artery, and segmental coronary atherosclerotic plaque area and EBCT coronary calcium area but suggests that there is a threshold value for plaque area below which coronary calcium is either absent or not detectable by this methodology.
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