Author + information
- Kamran Akram, MD and
- Szilard Voros, MD⁎ ()
- ↵⁎Fuqua Heart Center of Atlanta, Piedmont Hospital, 1968 Peachtree Road NW, Atlanta, Georgia 30309
The study by Henneman et al. (1) included 40 consecutive patients with suspected acute coronary syndrome who underwent coronary artery calcium (CAC) scoring and computed tomography coronary angiography. Of the entire cohort of 40 patients, 5 had obstructive disease and no presence of CAC. The authors concluded that in this cohort absence of CAC does not reliably rule out significant atherosclerosis.
Knez et al. (2) studied 2,115 consecutive symptomatic patients with no prior diagnosis of coronary artery disease (CAD), finding CAC in over 99% of patients with obstructive CAD. No calcium was found in 7 of 872 men (0.7%) and in 1 of 383 women (0.02%) who had significant luminal stenosis on coronary angiography. Seven of these 8 patients with missed obstructive disease and scores of zero were <45 years old, indicating that age is a major factor influencing the predictive value of CAC for obstructive disease.
In a recent publication from our center (3) including 210 patients (134 with chest pain) referred for CAC scoring and computed tomography coronary angiography, we found 4 patients who had absence of any CAC and obstructive CAD (>70% narrowing). All of those patients had the presence of chest pain, and 3 of the 4 were younger than 45 years of age.
Such publications indicate that the performance of CAC to predict obstructive disease is not only influenced by symptomatic status but also by age. We would be very interested in learning about the age distribution of patients with zero CAC and obstructive disease. If the authors could provide information on the age of these patients, that would be quite valuable in furthering the understanding of the role of symptoms and age in the interpretation of CAC.
- American College of Cardiology Foundation
- Henneman M.M.,
- Schuijf J.D.,
- Pundziute G.,
- et al.
- Akram K.,
- O'Donnell R.E.,
- King S.,
- et al.