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Clinical Case
New Delhi, June 19, 2019 :
healthy soch : A 46 year old female came with a typical chest pain with reported wall motions on echo and questionable CAD on CT angiography. She was put on treatment for the last six months and was now advised EECP and chelation therapy. The patient came for a third opinion.
A : On reviewing the CT report it was found she had a coronary calcium score of zero. She was put of lifestyle advise.
Discussion
American Heart Association: CAC score of zero (CAC=0; ie, no calcified plaque detected) indicate that
1.the presence of atherosclerotic plaque, including unstable or vulnerable plaque is highly unlikely
2.that the presence of significant luminal obstructive disease is highly unlikely (negative predictive value on the order of 95% to 99%)
3.that the risk of a cardiovascular event in the next 2 to 5 years is quite low (0.1 per 100 person-years).
4.CAC=0 is useful in the emergency room setting as a tool to rule out myocardial ischemia in symptomatic patients.
The presence of CAC is highly sensitive for the presence of ≥50 percent angiographic stenosis in moderately specific, especially in older patients.The absence of CAC, particularly in an asymptomatic patient, is highly predictive of the absence of significant coronary artery stenosis and implies a favorable prognosis.
CAC screening, especially for borderline and intermediate risk patients, can enhance the prediction of risk in asymptomatic individuals and increase the predictive value of the Framingham Risk Score.Among asymptomatic patients with a low Framingham risk score (<10 percent 10-year risk), only a small number (less than 15 percent) of those with CAC will have a cardiac event over the ensuing five years.
CAC screening is unlikely to benefit low- or high-risk (>20 percent 10-year risk) patients, and is not recommended.It has not been established that instituting or intensifying pharmacologic risk factor modification in asymptomatic patients with CAC improves outcomes.
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