Abstract
Background Non-contrast computed tomography (CT) scanning allows for reliable coronary calcium score (CCS) calculation at a low radiation dose and has been well established as marker to assess the future risk of coronary artery disease (CAD) events in asymptomatic individuals. However, the diagnostic and prognostic value in symptomatic patients remains
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a matter of debate. This narrative review focuses on the available evidence for CCS in patients with stable chest pain complaints. Method  PubMed, Embase, and Web of Science were searched for literature using search terms related to three overarching categories: CT, symptomatic chest pain patients, and coronary calcium. The search resulted in 42 articles fulfilling the inclusion and exclusion criteria: 27 articles (n=38137 patients) focused on diagnostic value and 23 articles (n=44683 patients) on prognostic value of CCS.Of these, 10 articles (n=21208 patients) focused on both the diagnostic and prognostic value of CCS. Results  Between 22 and 10037 patients were included in the studies on the diagnostic and prognostic value of CCS, including 43% and 51% patients with CCS 0. The most evidence is available for patients with a low and intermediate pre-test probability (PTP) of CAD. Overall, the prevalence of obstructive CAD(OCAD, defined as a luminal stenosis of ≥50% in any of the coronary arteries) as determined with CT coronary angiography in CCS 0 patients, was 4.4% (n=703/16074) with a range of 0-26% in individual studies. The event rate for major adverse cardiac events (MACE) ranged from 0% to 2.1% during a follow-up of 1.6 to 6.8 years, resulting in a high negative predictive value for MACE between 98% and 100% in CCS 0 patients. At increasing CCS, the OCADprobability and MACE risk increased. OCADwas present in 58.3% (n=617/1058) of CCS>400 patients with percentages ranging from 20% to 94% and MACE occurred in 16.7% (n=175/1048) of these patients with percentages ranging from 6.9% to 50%. Conclusion  Accumulating evidence shows that OCADis unlikely and the MACE risk is very low in symptomatic patients with CCS 0, especially in those with low and intermediate PTPs. This suggests a role of CCS as a gatekeeper for additional diagnostic testing. Increasing CCS is related to an increasing probability of OCADand risk of cardiac events. Additional research is needed to assess the value of CCS in women and patient management in a primary healthcare setting. Key Points:   A CCS of zero makes OCADin patients at low-intermediate PTP unlikely A CCS of zero is related to a very low risk of MACE Categories of increasing CCS are related to increasing rates of OCADand MACE Future studies should focus on the diagnostic and prognostic value of CCS in symptomatic women and the role in primary care Citation Format Koopman MY, Willemsen RT, van der Harst P etal. The Diagnostic and Prognostic Value of Coronary Calcium Scoring in Stable Chest Pain Patients: A Narrative Review. Fortschr Röntgenstr 2022; 194: 257-265.
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