Does coronary CT angiography improve risk stratification over coronary artery calcium scoring in symptomatic patients with a low pre-test probability of coronary artery disease and a CAC of zero? Reply

摘要

We thank Dr Torres for his interest in our paper. We agree that patients with zero coronary calcium score (CCS) have a low prevalence of coronary artery disease (CAD) as well as a very low event rate, as has been shown before by our group and others. We further analysed our data to answer the question whether coronary computed tomography angiography (CCTA) adds an incremental prognostic value over CCS in patients with a zero CCS and a low pre-test probability. Amongthe4860 symptomatic patients with a zero CCS in our study, 3209 (66%) patients had a low pre-test likelihood. In this group, 1% of the patients had obstructive CAD and 12% had non-obstructive CAD, while the rest had normal coronaries. Atthe end of the follow-up duration, 16 patients experienced death/myocardial infarction. The event rate was 0.4% among patients with normal coronaries, 0.8% among patients with non-obstructive CAD, and 3.4% among patients with obstructive CAD (trend P = 0.052).