A calcium score of 0 predicted absence of epicardial coronary lesions much better in patients older than 57 (OR 10.8) than in younger patients (OR 1.92).
Does a calcium score of 0 better predict the absence of epicardial coronary lesions in older patients compared to younger patients with suspected acute coronary syndrome?
A calcium score of 0 is a significantly stronger predictor for the absence of obstructive epicardial coronary disease in older patients compared to younger patients presenting with suspected acute coronary syndrome.
Absolute Event Rate: 0% vs 0%
Abstract Introduction The use of coronary angiotomography in low-medium risk suspected acute coronary syndromes is a safe diagnostic tool that can rule out significant coronary stenosis, reducing the need for an invasive procedure such as a coronary angiogram. A calcium score of 0 is normally used as a marker of low atherosclerotic burden and of cardiovascular risk. However, in young patients, lipid rich (and therefore high risk) plaques could exist that have not yet been calcified, and therefore the negative predictive value of a calcium score of 0 could be diminished. In contrast, older patients have had time to calcify existing plaques, and therefore a score of 0 could have greater value in this scenario. Methods We analyzed a prospectivelly collected database of coronary AngioCT in low to middle risk suspected acute coronary syndromes that came to the emergency department at our institution. We divided patients according to whether they were younger or older than the median age. We ran a univariate and multivariate analysis by backward logistic regression to determine if the presence of calcium score 0 was a better predictor of absense of epicardial coronary lesions if patients were older. Results 445 patients were included in the analysis. 56.9% were female, 43% had a hystory of hypertension, 59.3% of dyslipidemia, 20% relevant family history, 15% diabetic. Median age was 57 years old (IQR 48-67). 46.7% had a calcium score of 0. After univariate analysis, the calcium score of 0, the combination of 0 score and age below the median, and the combination of 0 and above the median were all significantly associated with abscense of epicardial coronary lesions, as were sex and age. After multivariate analysis, the combination of 0 score and age below the median had an OR for predicting abscense of epicardial coronary lesions of 1.92 (1.014-3.67), while an age above the median and score 0 had an OR of 10.8 (4.8-24.8). Conclusions Our analysis showed that a calcium score of 0 in suspected acute coronary syndrome patients was a better predictor of abscense of epicardial lesions in patients older than the median than in those that were younger.Main figure
Chapman et al. (Sat,) reported a other. A calcium score of 0 predicted absence of epicardial coronary lesions much better in patients older than 57 (OR 10.8) than in younger patients (OR 1.92).