Why the study?
To estimate the prevalence of non-calcified CAD and assess prognostic significance in patients with suspected stable angina presenting with a zero CAC score.
Does a zero CAC score predict a lower risk of MACE compared to a non-zero CAC score in patients with suspected stable angina?
Population
1753 consecutive patients with stable chest pain at a single tertiary centre
Comparison
Zero CAC score vs non-zero CAC score
Design
Single-centre prospective cohort study
Follow-up
Median 2.2 years (range 1.0-7.0 years)
Key result
A zero CAC score in patients with suspected stable angina was associated with a low absolute rate of MACE (1.9 vs 7.4 per 1000 person-years), with no significant difference after adjustment (p=0.19).
Authors
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Zero CAC signals low obstructive CAD risk and good prognosis in stable angina; leaves open whether CTCA adds incremental value beyond CAC scoring.
Cohort (n=1,753)
No
Does a zero CAC score predict a lower risk of MACE compared to a non-zero CAC score in patients with suspected stable angina?
Hazard Ratio: 3.8
Absolute Event Rate: 1.9% vs 7.4%
p-value: p=0.009
A zero CAC score in patients with suspected stable angina has a high negative predictive value for obstructive CAD and is associated with a low absolute rate of MACE, though not statistically different from non-zero CAC after multivariable adjustment.
Wang et al. (2019) conducted a cohort in suspected stable angina (n=1,753). Zero coronary artery calcification (CAC) score vs. Non-zero CAC score was evaluated on Major adverse cardiac event (MACE) defined as cardiac death, non-fatal myocardial infarction and/or non-elective revascularisation (HR 3.8, p=0.009). A zero CAC score in patients with suspected stable angina was associated with a low absolute rate of MACE (1.9 vs 7.4 per 1000 person-years), with no significant difference after adjustment (p=0.19).
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