Predictive Value of a Zero Coronary Artery Calcium Score in Major Adverse Cardiac Events in Old Age

By estimating the total coronary plaque burden, the Coronary Artery
Calcium (CAC) score determines the risk of Coronary Artery Disease (CAD). The
presence of a zero CAC score may be highly predictive of very low risk patients forMajor
Cardiac Adverse Events (MACEs) due to its close relation with the severity of CAD.
Objective: The present study aimed to evaluate the value of a zero CAC score for
predicting MACEs in patients older than 60 years suspected of CAD.
Methods: Between April 2011 and March 2012, 128 patients aged > 60 years with a
zero CAC score on admission without a previous history of CAD were consecutively
included in this study with a mean follow-up period of 45.7 months. The continuous
variables were compared using t-test or Mann–Whitney U test and the categorical ones
were compared using chi-square test. The statistical analyses were done using the SPSS
statistical software, version 23.0.
Results: This study was conducted on 128 patients (35 males and 93 females). The
incidence of MACEs was 2.3% in a mean follow-up period of 45.7 months and 0.6 per
100 patient-years. Additionally, the MACE-free survival rates were 99.1%, 99.1%, and
87.7% in one, three, and five years, respectively. The negative predictive value of a zero
CAC score for predicting long-termMACEs was 100% in the patients older than 70 years
and 96.8% in those aged between 60 and 70 years. No cardiac-related death was recorded
within the follow-up period.
Conclusion: A zero CAC score had a high negative predictive value for predicting long-
termMACEs in elderly patients withmild tomoderate pretest probability of CAD, which
reached 100% among the patients older than 70 years.