Prevalence of coronary artery disease in symptomatic patients with zero coronary artery calcium score in different age p
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ORIGINAL PAPER
Prevalence of coronary artery disease in symptomatic patients with zero coronary artery calcium score in different age population Yi‑tong Yu1 · Zhi‑hui Hou1 · Bin Lu1 · Yun‑qiang An1 · Yang Gao1 · Wei‑hua Yin1 · Xin‑shuang Ren1 Received: 29 July 2020 / Accepted: 12 September 2020 © Springer Nature B.V. 2020
Abstract There is controversy about whether symptomatic population with coronary artery calcium score (CACS) of zero have coronary artery disease (CAD) and the distribution at different ages. We sought to analyze the prevalence of CAD in symptomatic patients with zero CACS, especially in different age groups. We studied patients suspected of CAD and underwent CACS scan and coronary computed tomography angiography (CTA). We included patients with CACS of zero. Clinical data was collected to achieve information on demographic characteristics and risk factors. The presence of plaque and obstructive CAD were analyzed based on coronary CTA. The association between age and the prevalence of plaque and obstructive CAD was evaluated.Overall 5514 patients (51.1% men; mean age 54.40 years) were analyzed, of whom 4120 (74.72%) with normal coronary artery, 1394 (25.28%) with plaque and 514 (9.32%) with obstructive CAD. The prevalence of plaque and obstructive CAD increased significantly with age (p 70). RRs of prevalence of obstructive CAD also increased with age in the multivariate model (RR = 2.075 for 40–50, RR = 4.102 for > 70). Quite a few CAD could occur in symptomatic patients with CACS of zero, especially in old patients. Coronary CTA was required to exclude CAD in this cohort. Keywords Coronary artery calcium score · Coronary artery disease · Coronary computed tomography angiography · Age
Introduction The presence of calcium in coronary arteries is the pathognomonic feature of atherosclerosis, as confirmed by histopathology studies [1, 2]. Absence of calcium in coronary arteries might reliably exclude obstructive coronary artery disease (CAD) in asymptomatic individuals and seems to be associated with a low cardiovascular event rate, suggesting that less aggressive pharmacotherapy might be indicated in this population [3]. However, a series of studies also revealed that patients with coronary artery calcium score (CACS) of zero had probability of significant coronary stenosis [4]. * Bin Lu [email protected] 1
Department of Radiologic Imaging, Fu Wai Hospital, State Key Lab and National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, #167 Bei‑Li‑Shi Street, Xi‑Cheng District, 100037 Beijing, People’s Republic of China
The lipid-filled non-calcified atherosclerotic plaque are most vulnerable and could cause subsequent clinical events [5, 6], therefore, coronary computed tomography angiography (CTA) is required to exclude non-calcified atherosclerotic plaque and obstructive CAD. In the CONFIRM registry, which involved 10,037 patients who underwent both CACS scan and coronary CTA, 13% of patients with a CACS of zero had non-obstructive sten
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