Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
Eur Heart J Cardiovasc Imaging. 2012 Sep;13(9):776-85. doi: 10.1093/ehjci/jes060. Epub 2012 Mar 29.
The clinical implication of a zero coronary calcium score (CCS) in patients with chest pain syndrome has been under debate. This study was undertaken to determine the meaning of a CCS of zero in a large sample of symptomatic patients referred for coronary computed tomographic (CT) angiography.
We consecutively enrolled 2088 patients (age 58 ± 10 years, 1028 men) who had undergone 64-slice cardiac CT due to chest pain syndrome. A CCS of zero was detected in 1114 patients (471 men and 643 women). Of these 1114 patients, obstructive coronary artery disease (CAD) was found in a total of 48 patients (4.3%); 35 men (7.4%) and 13 women (2.0%). Among the zero CCS patients with obstructive CAD, men had a higher prevalence of both premature CAD (49 vs. 0%) and multivessel disease (20 vs. 8%) than women. During the follow-up period (1033 ± 136 days), early revascularization was done in 25 patients (2.2%, 18 men and 7 women) and there were 14 major adverse cardiac events (1.3%, 8 men and 7 women) among the zero CCS patients. CAD severity was a strong prognostic indicator in the zero CCS patients.
A CCS of zero cannot be used by itself to exclude obstructive CAD in symptomatic patients referred for coronary CT angiography (CCTA). The prevalence of obstructive CAD and adverse cardiac events are not negligible in symptomatic patients with a CCS of zero, and CAD severity by CCTA is associated with higher rates of adverse cardiac event.
关于胸痛综合征患者冠状动脉钙评分（CCS）为零的临床意义一直存在争议。本研究旨在确定在大量因胸痛综合征而接受冠状动脉计算机断层扫描（CT）血管造影的有症状患者中，CCS 为零时的意义。
我们连续纳入了 2088 名（年龄 58 ± 10 岁，1028 名男性）因胸痛综合征接受 64 层心脏 CT 的患者。在 1114 名患者（471 名男性和 643 名女性）中检测到 CCS 为零。在这 1114 名患者中，共有 48 名（4.3%；35 名男性[7.4%]和 13 名女性[2.0%]）患有阻塞性冠状动脉疾病（CAD）。在 CCS 为零且有阻塞性 CAD 的患者中，男性患有早发 CAD（49%比 0%）和多支血管疾病（20%比 8%）的患病率更高。在随访期间（1033 ± 136 天），25 名患者（2.2%，18 名男性和 7 名女性）接受了早期血运重建，在 CCS 为零的患者中发生了 14 例主要不良心脏事件（1.3%，8 名男性和 7 名女性）。CAD 严重程度是 CCS 为零患者的一个强有力的预后指标。
CCS 为零不能单独用于排除因 CCTA 而接受冠状动脉 CT 血管造影（CCTA）的有症状患者中的阻塞性 CAD。CCS 为零时，有症状患者的阻塞性 CAD 和不良心脏事件的发生率并不低，CCTA 显示的 CAD 严重程度与不良心脏事件发生率较高相关。
