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Evaluation of coronary artery calcium (CAC) by computed tomography (CT) has been proposed as a filter before invasive diagnostic procedures or hospital admission in symptomatic patients. This proposal is based on data suggesting that low CAC scores are associated with low risk for obstructive coronary artery disease (CAD). In a substudy of an international trial of angiographic methodologies, investigators analyzed the prevalence of obstructive CAD (≥50% stenosis) in 291 symptomatic patients for whom CAC scores were available (obtained ≤30 days before angiography). Patients with CAC scores >600 were excluded.
Overall prevalence of obstructive CAD, as identified by angiography, was 56%, and 14 of the 72 patients (19%) with CAC scores of 0 had…