Evidence map›Paper›PMID 36873724›Full record

ReviewThe British journal of cardiology2022

Age and the power of zero CAC in cardiac risk assessment: overview of the literature and a cautionary case.

John P Sheppard, Suvasini Lakshmanan, Seth J Lichtenstein, Matthew J Budoff, Sion K Roy

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PubMed Full text at PMC Publisher
In one paragraph

Review in The British journal of cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
2.4field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 17 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

John P SheppardResident Physician Department of Internal Medicine, Yale New Haven Hospital, 20 York Street, New Haven, Connecticut, 06510, USA.
Suvasini LakshmananPhysician Fellow Division of Cardiovascular Medicine, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa, 52242, USA.
Seth J LichtensteinPhysician Fellow Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California, 90502, USA.
Matthew J BudoffProfessor of Medicine, David Geffen School of Medicine at UCLA, Investigator, Lundquist Institute, and Program Director and Director of Cardiac CT Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California, 90502, USA.
Sion K RoyAssociate Program Director and Director of Inpatient Cardiac CT Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California, 90502, USA.
UCLA Medical Center · USUniversity of Iowa Hospitals and Clinics · USYale New Haven Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The coronary artery calcium (CAC) score is a marker of advanced coronary atherosclerosis. Numerous prospective cohorts have validated CAC as an independent marker that improves prognostication in atherosclerotic cardiovascular disease (ASCVD) beyond traditional risk factors. Accordingly, CAC is now incorporated into international cardiovascular guidelines as a tool to inform medical decision-making. Particular interest concerns the significance of zero CAC score (CAC=0). While many studies report CAC=0 to virtually exclude obstructive coronary artery disease (CAD), non-negligible rates of obstructive CAD despite CAC=0 are reported in certain populations. Overall, the current literature supports the power of zero CAC as a strong downward risk classifier in older patients, whose CAD burden predominantly involves calcified plaque. However, with their higher burden of non-calcified plaque, CAC=0 does not reliably exclude obstructive CAD in patients under 40 years. Illustrating this point, we present a cautionary case of a 31-year-old patient found to have severe two-vessel CAD despite CAC=0. We highlight the value of coronary computed tomography angiography (CCTA) as the gold-standard non-invasive imaging modality when the diagnosis of obstructive CAD is in question.

Indexed as

calcium scorecoronary artery calciumcoronary computed tomography angiography (CCTA)heart disease risk factors

Identifiers

PMID36873724
PMCPMC9982666
OpenAlexW4285820986

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.