Document Detail

Diagnostic and prognostic value of absence of coronary artery calcification.
MedLine Citation:
PMID:  19520336     Owner:  NLM     Status:  MEDLINE    
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 (e.g., 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 (0.56%) 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, 1.80% 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.
Ammar Sarwar; Leslee J Shaw; Michael D Shapiro; Ron Blankstein; Udo Hoffmann; Udo Hoffman; Ricardo C Cury; Suhny Abbara; Thomas J Brady; Matthew J Budoff; Roger S Blumenthal; Khurram Nasir
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-12     Completed Date:  2009-09-01     Revised Date:  2014-09-09    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  675-88     Citation Subset:  IM    
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MeSH Terms
Acute Coronary Syndrome / complications
Calcinosis / complications,  radiography*
Coronary Angiography
Coronary Artery Disease / complications,  radiography*
Coronary Stenosis / complications,  radiography
Myocardial Ischemia / complications
Predictive Value of Tests
Sensitivity and Specificity
Tomography, X-Ray Computed
Grant Support
1 T32 HL076136-02/HL/NHLBI NIH HHS
Comment In:
JACC Cardiovasc Imaging. 2009 Jun;2(6):689-91   [PMID:  19520337 ]
Erratum In:
JACC Cardiovasc Imaging. 2010 Oct;3(10):1089
Note: Hoffman, Udo [corrected to Hoffmann, Udo]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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