Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score

Kamran Akram, Robert E. O'Donnell, Spencer King, H. Robert Superko, Arthur Agatston, Szilard Voros

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: CAC has been used to predict obstructive CAD on invasive coronary angiography. However, it is unknown how the prevalence of obstructive CAD in patients with zero CAC is influenced by the presence or absence of chest pain. Methods: 210 consecutive patients referred for CAC and CorCTA were included in this analysis. Chest pain was defined based on the Diamond-Forrester classification. Results: 134 patients (64%) were symptomatic and 76 (36%) were asymptomatic. Seventy patients had negative (33%); 140 had positive CAC (67%). In the symptomatic group with zero CAC, 8.2% (4/49) had an obstructive, non-calcified plaque; of these, 3 were <45 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CAC in the symptomatic population for detection of obstructive CAD were 0.86 (0.66-0.95), 0.42 (0.33-0.52), 0.28 (0.19-0.39) and 0.92 (0.8-0.97), respectively (p = 0.007). No asymptomatic subject with zero CAC had obstructive CAD. Sensitivity, specificity, PPV and NPV of CAC in the asymptomatic population for detection of obstructive CAD were 1.00 (0.66-1.00), 0.32 (0.21-0.45), 0.18 (0.10-0.31) and 1.00 (0.80-1.00), respectively (p = 0.05). Optimal cut-points to predict obstructive CAD and AUC were significantly different in symptomatic versus asymptomatic subjects (91 and 0.78 vs. 296 and 0.89, respectively) (p = 0.005). CAC performed much better in symptomatic patients >45 years compared to younger patients to exclude obstructive CAD (AUC: 0.83 vs. 0.5, p < 0.001; NPV = 0.98). Conclusions: CAC is better in asymptomatic compared to symptomatic subjects, especially in patients <age 45, to exclude obstructive CAD. Symptoms and age should be considered when interpreting CAC.

Original languageEnglish
Pages (from-to)533-537
Number of pages5
JournalAtherosclerosis
Volume203
Issue number2
DOIs
StatePublished - Apr 1 2009
Externally publishedYes

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Coronary Artery Disease
Calcium
Chest Pain
Diamond
Coronary Angiography
Area Under Curve

Keywords

  • Atherosclerosis
  • Chest pain
  • Coronary artery calcium
  • Multi-detector computed tomography
  • Obstructive coronary artery disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score. / Akram, Kamran; O'Donnell, Robert E.; King, Spencer; Superko, H. Robert; Agatston, Arthur; Voros, Szilard.

In: Atherosclerosis, Vol. 203, No. 2, 01.04.2009, p. 533-537.

Research output: Contribution to journalArticle

Akram, Kamran ; O'Donnell, Robert E. ; King, Spencer ; Superko, H. Robert ; Agatston, Arthur ; Voros, Szilard. / Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score. In: Atherosclerosis. 2009 ; Vol. 203, No. 2. pp. 533-537.
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abstract = "Background: CAC has been used to predict obstructive CAD on invasive coronary angiography. However, it is unknown how the prevalence of obstructive CAD in patients with zero CAC is influenced by the presence or absence of chest pain. Methods: 210 consecutive patients referred for CAC and CorCTA were included in this analysis. Chest pain was defined based on the Diamond-Forrester classification. Results: 134 patients (64{\%}) were symptomatic and 76 (36{\%}) were asymptomatic. Seventy patients had negative (33{\%}); 140 had positive CAC (67{\%}). In the symptomatic group with zero CAC, 8.2{\%} (4/49) had an obstructive, non-calcified plaque; of these, 3 were <45 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CAC in the symptomatic population for detection of obstructive CAD were 0.86 (0.66-0.95), 0.42 (0.33-0.52), 0.28 (0.19-0.39) and 0.92 (0.8-0.97), respectively (p = 0.007). No asymptomatic subject with zero CAC had obstructive CAD. Sensitivity, specificity, PPV and NPV of CAC in the asymptomatic population for detection of obstructive CAD were 1.00 (0.66-1.00), 0.32 (0.21-0.45), 0.18 (0.10-0.31) and 1.00 (0.80-1.00), respectively (p = 0.05). Optimal cut-points to predict obstructive CAD and AUC were significantly different in symptomatic versus asymptomatic subjects (91 and 0.78 vs. 296 and 0.89, respectively) (p = 0.005). CAC performed much better in symptomatic patients >45 years compared to younger patients to exclude obstructive CAD (AUC: 0.83 vs. 0.5, p < 0.001; NPV = 0.98). Conclusions: CAC is better in asymptomatic compared to symptomatic subjects, especially in patients",
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T1 - Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score

AU - Akram, Kamran

AU - O'Donnell, Robert E.

AU - King, Spencer

AU - Superko, H. Robert

AU - Agatston, Arthur

AU - Voros, Szilard

PY - 2009/4/1

Y1 - 2009/4/1

N2 - Background: CAC has been used to predict obstructive CAD on invasive coronary angiography. However, it is unknown how the prevalence of obstructive CAD in patients with zero CAC is influenced by the presence or absence of chest pain. Methods: 210 consecutive patients referred for CAC and CorCTA were included in this analysis. Chest pain was defined based on the Diamond-Forrester classification. Results: 134 patients (64%) were symptomatic and 76 (36%) were asymptomatic. Seventy patients had negative (33%); 140 had positive CAC (67%). In the symptomatic group with zero CAC, 8.2% (4/49) had an obstructive, non-calcified plaque; of these, 3 were <45 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CAC in the symptomatic population for detection of obstructive CAD were 0.86 (0.66-0.95), 0.42 (0.33-0.52), 0.28 (0.19-0.39) and 0.92 (0.8-0.97), respectively (p = 0.007). No asymptomatic subject with zero CAC had obstructive CAD. Sensitivity, specificity, PPV and NPV of CAC in the asymptomatic population for detection of obstructive CAD were 1.00 (0.66-1.00), 0.32 (0.21-0.45), 0.18 (0.10-0.31) and 1.00 (0.80-1.00), respectively (p = 0.05). Optimal cut-points to predict obstructive CAD and AUC were significantly different in symptomatic versus asymptomatic subjects (91 and 0.78 vs. 296 and 0.89, respectively) (p = 0.005). CAC performed much better in symptomatic patients >45 years compared to younger patients to exclude obstructive CAD (AUC: 0.83 vs. 0.5, p < 0.001; NPV = 0.98). Conclusions: CAC is better in asymptomatic compared to symptomatic subjects, especially in patients

AB - Background: CAC has been used to predict obstructive CAD on invasive coronary angiography. However, it is unknown how the prevalence of obstructive CAD in patients with zero CAC is influenced by the presence or absence of chest pain. Methods: 210 consecutive patients referred for CAC and CorCTA were included in this analysis. Chest pain was defined based on the Diamond-Forrester classification. Results: 134 patients (64%) were symptomatic and 76 (36%) were asymptomatic. Seventy patients had negative (33%); 140 had positive CAC (67%). In the symptomatic group with zero CAC, 8.2% (4/49) had an obstructive, non-calcified plaque; of these, 3 were <45 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CAC in the symptomatic population for detection of obstructive CAD were 0.86 (0.66-0.95), 0.42 (0.33-0.52), 0.28 (0.19-0.39) and 0.92 (0.8-0.97), respectively (p = 0.007). No asymptomatic subject with zero CAC had obstructive CAD. Sensitivity, specificity, PPV and NPV of CAC in the asymptomatic population for detection of obstructive CAD were 1.00 (0.66-1.00), 0.32 (0.21-0.45), 0.18 (0.10-0.31) and 1.00 (0.80-1.00), respectively (p = 0.05). Optimal cut-points to predict obstructive CAD and AUC were significantly different in symptomatic versus asymptomatic subjects (91 and 0.78 vs. 296 and 0.89, respectively) (p = 0.005). CAC performed much better in symptomatic patients >45 years compared to younger patients to exclude obstructive CAD (AUC: 0.83 vs. 0.5, p < 0.001; NPV = 0.98). Conclusions: CAC is better in asymptomatic compared to symptomatic subjects, especially in patients

KW - Atherosclerosis

KW - Chest pain

KW - Coronary artery calcium

KW - Multi-detector computed tomography

KW - Obstructive coronary artery disease

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