Background

There is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing.

Objectives

The purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA).

Methods

The authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP.

Results

In this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate).

Conclusions

Among over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a “gatekeeper” for more advanced imaging among patients presenting with CP.

中文翻译：

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CAC 零对胸痛患者的预后价值

背景

对于缺乏冠状动脉钙（CAC）是否可以识别可以安全地避免额外下游检测的胸痛（CP）患者，目前尚未达成共识。

目标

本研究的目的是进行系统回顾和荟萃分析，调查 CAC 评估在稳定和急性 CP 患者中排除阻塞性冠状动脉疾病 (CAD) 的效用，这些患者患有阻塞性 CAD 的风险为低至中度。冠状动脉计算机断层扫描血管造影（CTA）。

方法

作者搜索了在线数据库，查找 2005 年至 2021 年间发表的研究，这些研究通过冠状动脉 CTA 检测稳定型和急性 CP 患者中 CAC 与阻塞性 CAD（≥50% 冠状动脉管腔狭窄）之间的关系。

结果

在这篇综述中，作者纳入了 19 篇论文，其中包括 79,903 名稳定 CP 患者，以及 13 篇论文，其中包括 12,376 名接受同时 CAC 和冠状动脉 CTA 评估的急性 CP 患者。总体而言，45%（95% CI：40%-50%）的稳定 CP 患者和 58%（95% CI：50%-66%）的急性 CP 患者的 CAC = 0。CAC 的阴性预测值= 0 排除阻塞性 CAD 在稳定期和急性 CP 患者中分别为 97% (95% CI: 96%-98%) 和 98% (95% CI: 96%-99%)。此外，在 CAC = 0 的患者中，在稳定 CP 的患者中，非阻塞性​​ CAD 的患病率为 13%（95% CI：10%-16%），在急性 CP 的患者中，非阻塞性​​ CAD 的患病率为 9%（95% CI：5%-13%）。 CP。CAC 评分为零预示着稳定 CP（年事件发生率 0.5%）和急性 CP（总体事件发生率 0.8%）患者主要不良心脏事件的发生率较低。

结论

在超过 92,000 名稳定或急性 CP 患者中，不存在 CAC 与阻塞性 CAD 患病率极低、非阻塞性 CAD 患病率低以及主要不良心脏事件的年化风险低相关。这些发现支持 CAC = 0 在基于价值的医疗保健提供模式中作为 CP 患者进行更高级成像的“看门人”的作用。