Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification
Objectives In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals. Background Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher ri...
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| Veröffentlicht in: | JACC. Cardiovascular imaging 2009-06, Vol.2 (6), p.675-688 |
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| creator | Sarwar, Ammar, MD Shaw, Leslee J., PhD Shapiro, Michael D., DO Blankstein, Ron, MD Hoffman, Udo, MD, MPH Cury, Ricardo C., MD Abbara, Suhny, MD Brady, Thomas J., MD Budoff, Matthew J., MD Blumenthal, Roger S., MD Nasir, Khurram, MD, MPH |
| description | Objectives In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals. Background Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes. Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events. Methods We searched online databases (e.g., PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC. Results A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion. These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients. In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months. In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 1.80% of patients without CAC had a cardiovascular event. Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography. In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia. Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome. Conclusions On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group. |
| doi_str_mv | 10.1016/j.jcmg.2008.12.031 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67355726</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1936878X09001727</els_id><sourcerecordid>67355726</sourcerecordid><originalsourceid>FETCH-LOGICAL-c392t-165aea281e4493c769da28598334540823a631c8c7caca8eb7ee68b3f02a96ff3</originalsourceid><addsrcrecordid>eNpFkUlLxEAQhRtRHLc_4EFy8pbYS9LLRRjGFQUFF7w1PT2VoWMmrd2J4L-344x4qip49aj3FULHBBcEE37WFI1dLQuKsSwILTAjW2iPSMFzUSmynXrFeC6FfJug_RgbjDnmpdhFE6Iqihnje-juwpll52PvbGa6RfYY_N_4atoBMl9n03mEzv62Mx98Z8J3Ng09pDIzrXW1s6Z3vjtEO7VpIxxt6gF6ubp8nt3k9w_Xt7PpfW6Zon1OeGXAUEmgLBWzgqtFmiolGSurEkvKDGfESiussUbCXABwOWc1pkbxumYH6HTt-xH85wCx1ysXLbSt6cAPUXPBqkpQnoR0LbTBxxig1h_BrdL5mmA9ItSNHhHqEaEmVCeEaelk4z7MV7D4X9kwS4LztQBSxi8HQdvWdYlB-w7fEBs_hC7F10TH5Kifxi-MT8AKYyKoYD9NlIKb</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67355726</pqid></control><display><type>article</type><title>Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Sarwar, Ammar, MD ; Shaw, Leslee J., PhD ; Shapiro, Michael D., DO ; Blankstein, Ron, MD ; Hoffman, Udo, MD, MPH ; Cury, Ricardo C., MD ; Abbara, Suhny, MD ; Brady, Thomas J., MD ; Budoff, Matthew J., MD ; Blumenthal, Roger S., MD ; Nasir, Khurram, MD, MPH</creator><creatorcontrib>Sarwar, Ammar, MD ; Shaw, Leslee J., PhD ; Shapiro, Michael D., DO ; Blankstein, Ron, MD ; Hoffman, Udo, MD, MPH ; Cury, Ricardo C., MD ; Abbara, Suhny, MD ; Brady, Thomas J., MD ; Budoff, Matthew J., MD ; Blumenthal, Roger S., MD ; Nasir, Khurram, MD, MPH</creatorcontrib><description>Objectives In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals. Background Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes. Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events. Methods We searched online databases (e.g., PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC. Results A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion. These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients. In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months. In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 1.80% of patients without CAC had a cardiovascular event. Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography. In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia. Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome. Conclusions On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group.</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2008.12.031</identifier><identifier>PMID: 19520336</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Coronary Syndrome - complications ; Calcinosis - complications ; Calcinosis - diagnostic imaging ; Cardiovascular ; Coronary Angiography ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnostic imaging ; Coronary Stenosis - complications ; Coronary Stenosis - diagnostic imaging ; Humans ; Myocardial Ischemia - complications ; Predictive Value of Tests ; Prognosis ; Sensitivity and Specificity ; Tomography, X-Ray Computed</subject><ispartof>JACC. Cardiovascular imaging, 2009-06, Vol.2 (6), p.675-688</ispartof><rights>American College of Cardiology Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c392t-165aea281e4493c769da28598334540823a631c8c7caca8eb7ee68b3f02a96ff3</citedby><cites>FETCH-LOGICAL-c392t-165aea281e4493c769da28598334540823a631c8c7caca8eb7ee68b3f02a96ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19520336$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sarwar, Ammar, MD</creatorcontrib><creatorcontrib>Shaw, Leslee J., PhD</creatorcontrib><creatorcontrib>Shapiro, Michael D., DO</creatorcontrib><creatorcontrib>Blankstein, Ron, MD</creatorcontrib><creatorcontrib>Hoffman, Udo, MD, MPH</creatorcontrib><creatorcontrib>Cury, Ricardo C., MD</creatorcontrib><creatorcontrib>Abbara, Suhny, MD</creatorcontrib><creatorcontrib>Brady, Thomas J., MD</creatorcontrib><creatorcontrib>Budoff, Matthew J., MD</creatorcontrib><creatorcontrib>Blumenthal, Roger S., MD</creatorcontrib><creatorcontrib>Nasir, Khurram, MD, MPH</creatorcontrib><title>Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>Objectives In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals. Background Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes. Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events. Methods We searched online databases (e.g., PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC. Results A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion. These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients. In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months. In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 1.80% of patients without CAC had a cardiovascular event. Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography. In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia. Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome. Conclusions On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group.</description><subject>Acute Coronary Syndrome - complications</subject><subject>Calcinosis - complications</subject><subject>Calcinosis - diagnostic imaging</subject><subject>Cardiovascular</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Stenosis - complications</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Humans</subject><subject>Myocardial Ischemia - complications</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkUlLxEAQhRtRHLc_4EFy8pbYS9LLRRjGFQUFF7w1PT2VoWMmrd2J4L-344x4qip49aj3FULHBBcEE37WFI1dLQuKsSwILTAjW2iPSMFzUSmynXrFeC6FfJug_RgbjDnmpdhFE6Iqihnje-juwpll52PvbGa6RfYY_N_4atoBMl9n03mEzv62Mx98Z8J3Ng09pDIzrXW1s6Z3vjtEO7VpIxxt6gF6ubp8nt3k9w_Xt7PpfW6Zon1OeGXAUEmgLBWzgqtFmiolGSurEkvKDGfESiussUbCXABwOWc1pkbxumYH6HTt-xH85wCx1ysXLbSt6cAPUXPBqkpQnoR0LbTBxxig1h_BrdL5mmA9ItSNHhHqEaEmVCeEaelk4z7MV7D4X9kwS4LztQBSxi8HQdvWdYlB-w7fEBs_hC7F10TH5Kifxi-MT8AKYyKoYD9NlIKb</recordid><startdate>20090601</startdate><enddate>20090601</enddate><creator>Sarwar, Ammar, MD</creator><creator>Shaw, Leslee J., PhD</creator><creator>Shapiro, Michael D., DO</creator><creator>Blankstein, Ron, MD</creator><creator>Hoffman, Udo, MD, MPH</creator><creator>Cury, Ricardo C., MD</creator><creator>Abbara, Suhny, MD</creator><creator>Brady, Thomas J., MD</creator><creator>Budoff, Matthew J., MD</creator><creator>Blumenthal, Roger S., MD</creator><creator>Nasir, Khurram, MD, MPH</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090601</creationdate><title>Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification</title><author>Sarwar, Ammar, MD ; Shaw, Leslee J., PhD ; Shapiro, Michael D., DO ; Blankstein, Ron, MD ; Hoffman, Udo, MD, MPH ; Cury, Ricardo C., MD ; Abbara, Suhny, MD ; Brady, Thomas J., MD ; Budoff, Matthew J., MD ; Blumenthal, Roger S., MD ; Nasir, Khurram, MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c392t-165aea281e4493c769da28598334540823a631c8c7caca8eb7ee68b3f02a96ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute Coronary Syndrome - complications</topic><topic>Calcinosis - complications</topic><topic>Calcinosis - diagnostic imaging</topic><topic>Cardiovascular</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Stenosis - complications</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Humans</topic><topic>Myocardial Ischemia - complications</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sarwar, Ammar, MD</creatorcontrib><creatorcontrib>Shaw, Leslee J., PhD</creatorcontrib><creatorcontrib>Shapiro, Michael D., DO</creatorcontrib><creatorcontrib>Blankstein, Ron, MD</creatorcontrib><creatorcontrib>Hoffman, Udo, MD, MPH</creatorcontrib><creatorcontrib>Cury, Ricardo C., MD</creatorcontrib><creatorcontrib>Abbara, Suhny, MD</creatorcontrib><creatorcontrib>Brady, Thomas J., MD</creatorcontrib><creatorcontrib>Budoff, Matthew J., MD</creatorcontrib><creatorcontrib>Blumenthal, Roger S., MD</creatorcontrib><creatorcontrib>Nasir, Khurram, MD, MPH</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sarwar, Ammar, MD</au><au>Shaw, Leslee J., PhD</au><au>Shapiro, Michael D., DO</au><au>Blankstein, Ron, MD</au><au>Hoffman, Udo, MD, MPH</au><au>Cury, Ricardo C., MD</au><au>Abbara, Suhny, MD</au><au>Brady, Thomas J., MD</au><au>Budoff, Matthew J., MD</au><au>Blumenthal, Roger S., MD</au><au>Nasir, Khurram, MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2009-06-01</date><risdate>2009</risdate><volume>2</volume><issue>6</issue><spage>675</spage><epage>688</epage><pages>675-688</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>Objectives In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals. Background Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes. Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events. Methods We searched online databases (e.g., PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC. Results A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion. These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients. In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months. In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 1.80% of patients without CAC had a cardiovascular event. Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography. In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia. Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome. Conclusions On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group.</abstract><cop>United States</cop><pmid>19520336</pmid><doi>10.1016/j.jcmg.2008.12.031</doi><tpages>14</tpages></addata></record> |
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| subjects | Acute Coronary Syndrome - complications Calcinosis - complications Calcinosis - diagnostic imaging Cardiovascular Coronary Angiography Coronary Artery Disease - complications Coronary Artery Disease - diagnostic imaging Coronary Stenosis - complications Coronary Stenosis - diagnostic imaging Humans Myocardial Ischemia - complications Predictive Value of Tests Prognosis Sensitivity and Specificity Tomography, X-Ray Computed |
| title | Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification |
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