CORRESPONDENCE: LETTER TO THE EDITOR
Influence of Symptoms and Age on the Predictive Value of Coronary Artery Calcium Scanning
Kamran Akram, MD and
Szilard Voros, MD*
* Fuqua Heart Center of Atlanta, Piedmont Hospital, 1968 Peachtree Road NW, Atlanta, Georgia 30309 (Email: szilard.voros{at}piedmont.org).
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.
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1. Henneman MM, Schuijf JD, Pundziute G, et al. Noninvasive evaluation with multislice computed tomography in suspected acute coronary syndrome: plaque morphology on multislice computed tomography versus coronary calcium score J Am Coll Cardiol 2008;52:216-222.[Abstract/Free Full Text]2. Knez A, Becker A, Leber A, et al. Relation of coronary calcium scores by electron beam tomography to obstructive disease in 2,115 symptomatic patients Am J Cardiol 2004;93:1150-1152.[CrossRef][Web of Science][Medline] 3. Akram K, O'Donnell RE, King S, et al. Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score Atherosclerosis 2008Jul 19 [e-pub ahead of print].
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