Coronary Artery Calcium Testing in Patients with Chest Pain: Alive and Kicking
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NOVEL AND EMERGING RISK FACTORS (K. NASIR, SECTION EDITOR)
Coronary Artery Calcium Testing in Patients with Chest Pain: Alive and Kicking Josephine Harrington 1 & Purav Mody 1 & Ron Blankstein 2 & Khurram Nasir 3,4 & Michael J. Blaha 4 & Parag H. Joshi 1,4,5
# Springer Science+Business Media New York 2017
Abstract Purpose of Review We review the potential role of coronary artery calcium (CAC) scoring in the initial evaluation and risk stratification of patients with low- to moderate-risk, stable and acute, chest pain. Recent Findings A negative CAC score (CAC = 0) has a negative predictive value of 94–99% in symptomatic patients with a low to moderate pretest probability of coronary artery stenosis. The sensitivity is superior to that of stress testing, and the risks, costs, and need for expertise are less than that of coronary CT angiography. Additionally, patients with CAC = 0 have an extremely low risk of future adverse coronary events with an incidence of only 0.0–0.8%, whereas those with CAC > 0 have significantly higher event rates (2.5–18%). Summary In low-risk chest pain patients, a negative CAC score can effectively “rule out” an ischemic etiology in patients experiencing chest pain. Higher CAC scores are Drs. Josephine Harrington and Purav Mody contributed equally to this work. This article is part of the Topical Collection on Novel and Emerging Risk Factors * Parag H. Joshi [email protected] 1
Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
2
Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
3
Baptist Health South Florida, Miami, FL, USA
4
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
5
UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830, USA
associated with a proportionately increased risk of coronary artery stenosis and warrant further testing. CAC scoring can serve as an effective gatekeeper for further resource utilization given the high prevalence and excellent sensitivity of CAC = 0. Keywords Coronary artery calcium . Acute coronary syndrome (ACS) . Angina . Chest pain
Introduction Chest pain results in more than seven million patient visits to the emergency department (ED) and more than nine million patient visits to a physician’s office each year in the USA [1]. However, there is significant heterogeneity in the etiology of chest pain among these patients. In the outpatient setting, chronic, exertional chest pain is concerning for stable, obstructive coronary artery disease (CAD) and is commonly treated with medical therapy plus revascularization when appropriate. In the acute setting, sudden onset chest pain is concerning for an acute coronary syndrome (ACS) and requires timely treatment to prevent complications. However, more than 60% of those requiring admission to the hospital with possible ACS are free of cardiac disease [2]. Given the overall burden of chest pain
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