Young Jin Kim MD, Presenter: Nothing to Disclose

Jin Hur MD, Abstract Co-Author: Nothing to Disclose

Hye-Jeong Lee MD, Abstract Co-Author: Nothing to Disclose

Yoo Jin Hong, Abstract Co-Author: Nothing to Disclose

Ji Eun Nam MD, Abstract Co-Author: Nothing to Disclose

Byoung Wook Choi MD, Abstract Co-Author: Nothing to Disclose

Kyu Ok Choe MD, Abstract Co-Author: Nothing to Disclose

While it has been established that the coronary calcium score (CCS) have high negative predictive value for coronary events, the clinical implication of a zero CCS in patients with chest pain syndrome has been under debate. This study was undertaken to determine the meaning of a CCS of zero in a large sample of symptomatic patients referred for coronary CT angiography (CCTA).

Two thousand eighty-eight consecutive patients (1,028 men and 1,060 women) with symptoms of suspected CAD who had undergone cardiac CT were enrolled. Patients underwent a coronary artery calcium (CAC) scan and a CCTA with a 64-slice multi-detector CT. Their CCSs and the state of their coronary artery stenosis were analyzed. The distribution and extent of CAC were investigated according to age and sex. Prevalence of obstructive CAD by sex and CCS (defined with a strata of CAC=0, 0<CAC≤10, 10<CAC≤100, 100<CAC≤400, and CAC>400) were evaluated. Multivariate regression analysis was undertaken to determine associations between presence of obstructive CAD and patient characteristics.

A CCS of zero was detected in 1,115 (54%) of 2,088 patients (471 men and 644 women). Of these 1,115 patients, obstructive CAD was found in a total of 48 patients (4.3%); 35 men (7.4%) and 13 women (2.0%). In patients with zero CCS, male sex and diabetes were independently associated with obstructive CAD. Among the zero CCS patients with obstructive CAD, men had a higher prevalence of both premature CAD (49% vs. 0%) and multi-vessel disease (20% vs. 8%) than women. When patients were classified into five groups according to their CCSs, gender difference in prevalence of CAD was notably higher in the group with a CCS of zero than other CCS groups.

A CCS of zero cannot be used to by itself exclude obstructive CAD in symptomatic patients referred for CCTA. However, a CCS of zero has gender specific implications in symptomatic patients with zero CCS: even in symptomatic patients, a CCS of zero can be used as a gatekeeper to rule out obstructive CAD in young female patients without diabetes as it is used in the asymptomatic patients.

A CCS of zero can be used as a gatekeeper to rule out obstructive CAD in young female patients without diabetes as it is used in the asymptomatic patients.

Kim, Y, Hur, J, Lee, H, Hong, Y, Nam, J, Choi, B, Choe, K, Coronary Artery Disease in Symptomatic Patients with Zero Coronary Calcium Scores Referred for Coronary CT Angiography.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010050.html