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January 1, 2022British Journal of CardiologyOpen Access

A zero coronary artery calcium score reliably down-stratifies risk in older adults but does not reliably exclude obstructive coronary artery disease in adults under 40 years.

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Why the study?

While zero coronary artery calcium virtually excludes obstructive coronary artery disease in older patients, non-negligible rates of obstructive CAD despite CAC=0 are reported in certain populations, particularly those under 40 years.

Population

One 31-year-old patient

Design

Literature overview and case report

Key result

A zero coronary artery calcium score reliably down-stratifies risk in older adults but does not reliably exclude obstructive coronary artery disease in adults under 40 years.

Authors

JSJohn P. SheppardSLSuvasini LakshmananSLSeth J. Lichtenstein

Discussion

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Member takes

Overview

CAC=0 may refine ASCVD risk stratification; leaves open whether it should guide therapy in Level 5 evidence.

PICO

P
Population
A clinical review evaluating the diagnostic and prognostic value of a zero coronary artery calcium score across different age groups, including a cautionary case report of a 31-year-old man.
E
Exposure / Comparator
Zero coronary artery calcium (CAC) score

Limitations

  • CAC scoring only detects calcified plaque, missing non-calcified plaque which is more prevalent in younger patients.

Cite This Study

Sheppard et al. (2022) conducted a review in Coronary artery disease. Zero coronary artery calcium (CAC) score was evaluated. A zero coronary artery calcium score reliably down-stratifies risk in older adults but does not reliably exclude obstructive coronary artery disease in adults under 40 years.

synapsesocial.com/papers/6a6bdcb8547974b2dbf46befhttps://doi.org/10.5837/bjc.2022.023
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Assessing the reliability of coronary artery calcium score in symptomatic patients: challenging the 'power of zero'2024 · 1 citations
  2. 2Evaluating the Implications of a Coronary Artery Calcium Score of Zero (CAC = 0) in Modern Risk Prediction: Is Zero Truly Zero?2025 · 1 citations
  3. 3A zero coronary artery calcium score in patients with stable chest pain is associated with a good prognosis, despite risk of non-calcified plaques2019 · 47 citations
  4. 4Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients2021 · 130 citations
  5. 5Zero Coronary Artery Calcium as a Marker of Vascular Resilience in High-Risk Adults2026