Objectives: The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). Background: The frequency and clinical relevance of CAD in patients without CAC are unclear. Methods: We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. Results: Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). Conclusions: In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.
Bibliographical noteFunding Information:
The views expressed here are those of the authors only, and are not to be construed as those of the Department of the Army or Department of Defense. Dr. Villines has received speaker honoraria from Boehringer-Ingelheim. Dr. Achenbach has received grant support from Siemens and Bayer Schering Pharma . Dr. Budoff has received speaker honoraria from GE Healthcare. Dr. Cademartiri has received grant support from GE Healthcare ; and speaker honoraria from Bracco Diagnostics. Dr. Callister is on the Speaker's Bureau of GE Healthcare. Dr. Chinnaiyan has received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI . Dr. Chow has received research support from GE Healthcare, Pfizer, and AstraZeneca; and educational support from TeraRecon. Dr. Hausleiter has received research grant support from Siemens . Dr. Kaufmann has received research support from GE Healthcare; and grant support from the Swiss National Science Foundation . Dr. Maffei has received grant support from GE Healthcare ; and is a consultant for Servier. Dr. Raff has received grant support from Siemens , Blue Cross Blue Shield Blue Care MI , and Bayer Pharma . Dr. Min has received speaker honoraria and research support and serves on the medical advisory board of GE Healthcare.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine