Zero Calcium Score NPV — EECC MCQ
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Correct answer: E — A calcium score of 0 has a negative predictive value of ~95-99% for significant obstructive CAD — it effectively excludes significant stenosis in most clinical scenarios and is associated with very low 10-year cardiovascular event rates (<1-2%)
A CAC score of 0 provides powerful risk exclusion: (1) NPV for obstructive CAD: ~95-99% (very few patients with CAC 0 have significant stenosis — those who do typically have non-calcified/soft plaque, which is uncommon in the >50 age group); (2) 10-year MACE rate with CAC 0: <1-2% (MESA study); (3) the 'warranty period' of a zero CAC score: estimated at ~5 years (low risk for this duration before repeat screening may be warranted). Limitations: (1) young patients (<45) and those with acute symptoms may have non-calcified vulnerable plaque not detected by CAC scoring; (2) CAC does NOT exclude vasospastic angina or microvascular disease; (3) in symptomatic patients with high pre-test probability, CAC 0 does NOT exclude significant CAD (CTCA or functional testing should be performed). The ESC CCS Guidelines position CAC scoring as a risk modifier for asymptomatic individuals, not as a diagnostic test for symptomatic patients.
Reference: ESC (2021): CVD Prevention; ESC (2024): CCS