Zero Calcium Score — EECC MCQ
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Correct answer: B — A CAC score of zero has a very high negative predictive value (>95%) for excluding significant obstructive CAD and haemodynamically significant stenosis; further testing is generally not needed
A CAC score of zero has a very high negative predictive value (>95-99%) for excluding significant obstructive coronary artery disease, particularly in symptomatic patients with low-intermediate pre-test probability. It is associated with a very low 10-year CV event rate (<1-2%). However, a zero CAC does not completely exclude non-calcified (soft) plaque, which can cause ACS, though this is rare in the absence of any calcification. The 2024 ESC CCS Guidelines recognise CAC scoring as a useful tool to reclassify risk and guide further investigation in selected patients. If symptoms are typical despite zero CAC, further investigation may still be warranted.
Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes