CT Finds Heart Disease Despite Zero Coronary Artery Calcification

Coronary artery calcification (CAC) scores of zero don’t give patients a pass from obstructive coronary artery disease, according to a study using coronary computed tomography angiography (CCTA) on patients with symptoms of coronary artery disease.

What’s more, CAC scores shed no light beyond what was already clear from CCTA results, according to the report, published Nov. 9 in the Journal of the American College of Cardiology.

Todd C. Villines, MD, of Walter Reed National Military Medical Center, led a multi-center study of 10,037 symptomatic patients (56 percent men; average age 57) without CAD. Each underwent CCTA as well as CAC scoring.

Among patients with a CAC score of zero, 84 percent had no CAD, 13 percent had nonobstructive stenosis, and 3.5 percent had stenosis of 50 percent or more on CCTA.

During an average follow-up of 2.1 years, there was no difference in mortality among patients with a CAC score of zero regardless of the presence of CAD. Among 8,907 patients, 3.9 percent of the patients with a CAC score of zero and greater-than 50 percent stenosis experienced an event, compared with 0.8 percent of patients with a CAC score of zero and no obstructive CAD. Receiver-operator characteristic curve analysis showed that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA.