ArticleAtherosclerosis2014
Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease.
Article in Atherosclerosis, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 63 citations in OpenAlex.
- Association of Coronary Artery Calcium Score with Cardiovascular Outcomes in Patients Without Known Coronary Artery Disease.Life (Basel, Switzerland) · 2026Article
- Hypercholesterolemia Is the Only Risk Factor Consistently Associated with Coronary Calcification in Three European Countries-Euro CCAD Study.Diagnostics (Basel, Switzerland) · 2025Article
- The value of coronary calcium score in predicting clinical outcomes in patients with chronic coronary syndrome.BMC cardiovascular disorders · 2024Article
- Advanced CT Imaging for the Assessment of Calcific Coronary Artery Disease and PCI Planning.Journal of the Society for Cardiovascular Angiography & Interventions · 2024Review
- Prognosis of Zero Coronary Artery Calcium Score in Symptomatic Patients of South Asian Descent - an Experience from a Tertiary Care Center in Pakistan.Global heart · 2024Article
- Comparison of the RF-CL and CACS-CL models to estimate the pretest probability of obstructive coronary artery disease and predict prognosis in patients with stable chest pain and diabetes mellitus.Frontiers in cardiovascular medicine · 2024Article
- Preventive cardiology advances in the 2021 AHA/ACC chest pain guideline.American journal of preventive cardiology · 2022Article
- Article
- The Diagnostic and Prognostic Value of Coronary Calcium Scoring in Stable Chest Pain Patients: A Narrative Review.RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin · 2022Review
- Age and the power of zero CAC in cardiac risk assessment: overview of the literature and a cautionary case.The British journal of cardiology · 2022Review
- Staged testing as a solution to the challenges of testing lower risk patients.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Anatomic or functional testing in stable patients with suspected CAD: contemporary role of cardiac CT in the ISCHEMIA trial era.The international journal of cardiovascular imaging · 2020Review
- Coronary artery calcification score in migraine patients.Scientific reports · 2019Article
- Prevalence and predictors of frailty in a high-income developing country: A cross-sectional study.Qatar medical journal · 2019Article
- The feasibility of 1-stop examination of coronary CT angiography and abdominal enhanced CT.Medicine · 2018Article
- Age-gender distribution of coronary artery calcium score in a black African population in Ghana.Vascular health and risk management · 2018Article
- Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain.International journal of cardiology · 2017Observational
- Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score.European heart journal. Cardiovascular Imaging · 2017Observational
- Visual identification of coronary calcifications on attenuation correction CT improves diagnostic accuracy of SPECT/CT myocardial perfusion imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2017Article
- Independent prognostic value of coronary artery calcium score and coronary computed tomography angiography in an outpatient cohort of low to intermediate risk chest pain patients.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2016Article
Corrections and comments
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Authors and funding
18 authors at 4 institutions in 2 countries.
Funding
Abstract
objectiveTo evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients.
methodsRetrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥ 50% and ≥ 70% stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization).
resultsAmong 1145 included patients, the mean age was 55 ± 12 years and median follow up 2.4 (IQR: 1.5-3.5) years. Overall, 406 (35%) CCTA were normal, 454 (40%) had <50% stenosis, and 285 (25%) had ≥ 50% stenosis. The prevalence of ≥ 70% stenosis was 16%. Among 483 (42%) patients with CAC zero, 395 (82%) had normal CCTA, 81 (17%) <50% stenosis, and 7 (1.5%) ≥ 50% stenosis. 2 (0.4%) patients had ≥ 70% stenosis. For diagnosis of ≥ 50% stenosis, CAC had a sensitivity of 98% and specificity of 55%. The negative predictive value (NPV) for CAC was 99% for ≥ 50% stenosis and 99.6% for ≥ 70% stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥ 50% CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p < 0.001) with CAC versus 0.77 (p = 0.02) with CCTA.
conclusionAmong symptomatic patients with CAC zero, a 1-2% prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years.
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