Key result
Coronary artery calcium (CAC) > 0 was associated with an increased risk of MACE compared to CAC = 0 in asymptomatic (RR 4.05; 95% CI 2.91-5.63) and symptomatic (RR 6.06; 95% CI 4.23-8.68) patients.
Why the study?
To compare the risk of cardiovascular outcomes in asymptomatic and symptomatic patients without established coronary artery disease according to coronary artery calcium score.
Does a CAC score > 0 increase the risk of cardiovascular events in asymptomatic and symptomatic patients without established coronary artery disease?
Meta-Analysis (n=224,557)
Does a CAC score > 0 increase the risk of cardiovascular events in asymptomatic and symptomatic patients without established coronary artery disease?
The presence of any coronary artery calcium (CAC > 0) is strongly associated with an increased risk of MACE, all-cause mortality, and revascularization in both asymptomatic and symptomatic patients without established CAD.
Answers are grounded in this paper and cite their sources.
May support CAC scoring for risk stratification without known CAD; extends evidence of consistent MACE associations across asymptomatic and symptomatic groups.
BACKGROUND: Coronary artery calcium (CAC) is an indicator of atherosclerosis, and the CAC score is a useful noninvasive assessment of coronary artery disease. OBJECTIVE: To compare the risk of cardiovascular outcomes in patients with CAC > 0 versus CAC = 0 in asymptomatic and symptomatic population in patients without an established diagnosis of coronary artery disease. METHODS: A systematic search of electronic databases was conducted until January 2018 for any cohort study reporting cardiovascular events in patients with CAC > 0 compared with absence of CAC. RESULTS: Forty-five studies were included with 192 080 asymptomatic 32 477 symptomatic patients. At mean follow-up of 11 years, CAC > 0 was associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared to a CAC = 0 in asymptomatic arm [pooled risk ratio (RR) 4.05, 95% confidence interval (CI) 2.91-5.63, P < 0.00001, I2 = 80%] and symptomatic arm (pooled RR 6.06, 95% CI 4.23-8.68, P < 0.00001, I2 = 69%). CAC > 0 was also associated with increased risk of all-cause mortality in symptomatic population (pooled RR 7.94, 95% CI 2.61-24.17, P < 0.00001, I2 = 85%) and in asymptomatic population CAC > 0 was associated with higher all-cause mortality (pooled RR 3.23, 95% CI 2.12-4.93, P < 0.00001, I2 = 94%). In symptomatic population, revascularization in CAC > 0 was higher (pooled RR 15, 95% CI 6.66-33.80, P < 0.00001, I2 = 72) compared with CAC = 0. Additionally, CAC > 0 was associated with more revascularization in asymptomatic population (pooled RR 5.34, 95% CI 2.06-13.85, P = 0.0006, I2 = 93). In subgroup analysis of asymptomatic population by gender, CAC > 0 was associated with higher MACE (RR 6.39, 95% CI 3.39-12.84, P < 0.00001). CONCLUSION: Absence of CAC is associated with low risk of cardiovascular events compared with any CAC > 0 in both asymptomatic and symptomatic population without coronary artery disease.
No takes yet. Share an insight, caveat, or question.
Abuzaid et al. (2021) conducted a meta-analysis in Without established coronary artery disease (n=224,557). Coronary artery calcium (CAC) > 0 vs. CAC = 0 was evaluated on Major adverse cardiovascular and cerebrovascular events (MACE) in asymptomatic patients (RR 4.05, 95% CI 2.91-5.63, p=< 0.00001). Coronary artery calcium (CAC) > 0 was associated with an increased risk of MACE compared to CAC = 0 in asymptomatic (RR 4.05; 95% CI 2.91-5.63) and symptomatic (RR 6.06; 95% CI 4.23-8.68) patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: