Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score

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Title: Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score
Authors: Mittal, TK
Pottle, A
Nicol, E
Barbir, M
Ariff, B
Mirsadraee, S
Dubowitz, M
Gorog, DA
Clifford, P
Firoozan, S
Smith, R
Dubrey, S
Chana, H
Shah, J
Stephens, N
Travill, C
Kelion, A
Pakkal, M
Timmis, A
Item Type: Journal Article
Abstract: Aims: CT calcium scoring (CTCS) and CT cardiac angiography (CTCA) are widely used in patients with stable chest pain to exclude significant coronary artery disease (CAD). We aimed to resolve uncertainty about the prevalence of obstructive coronary artery disease and long-term outcomes in patients with a zero-calcium score (ZCS). Methods and results: Consecutive patients with stable cardiac symptoms referred for CTCS or CTCS and CTCA from chest pain clinics to a tertiary cardiothoracic centre were prospectively enrolled. In those with a ZCS, the prevalence of obstructive CAD on CTCA was determined. A follow-up for all-cause mortality was obtained from the NHS tracer service. A total of 3914 patients underwent CTCS of whom 2730 (69.7%) also had a CTCA. Half of the patients were men (50.3%) with a mean age of 56.9 years. Among patients who had both procedures, a ZCS was present in 52.2%, with a negative predictive value of 99.5% for excluding ≥70% stenosis on CTCA. During a mean follow-up of 5.2 years, the annual event rate was 0.3% for those with ZCS compared with 1.2% for CS ≥1. The presence of non-calcified atheroma on CTCA in patients with ZCS did not affect the prognostic value (P = 0.98). Conclusion: In patients with stable symptoms and a ZCS, obstructive CAD is rare, and prognosis over the long-term is excellent, regardless of whether non-calcified atheroma is identified. A ZCS could reliably be used as a ‘gatekeeper’ in this patient cohort, obviating the need for further more expensive tests.
Issue Date: 31-Mar-2017
Date of Acceptance: 16-Feb-2017
ISSN: 2047-2412
Publisher: Oxford University Press (OUP)
Start Page: 922
End Page: 929
Journal / Book Title: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
Volume: 18
Issue: 8
Copyright Statement: © The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Radiology, Nuclear Medicine & Medical Imaging
Cardiovascular System & Cardiology
coronary artery calcification
stable angina
coronary CT angiography
coronary artery disease
Publication Status: Published
Open Access location:
Appears in Collections:Clinical Sciences
Imaging Sciences
National Heart and Lung Institute

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