Coronary artery calcium score of zero does not rule out obstructive CAD in young adults
Bibliographic record
Abstract
Young adults are more likely to have non-calcified coronary plaques. Purpose to assess the predictive value of a zero-coronary artery calcium (CAC) score in young adults and to determine which clinical characteristics are associated with obstructive coronary heart disease. 6775 patients were prospectively entered a registry. They all had a CAC. Mean age 63 +/− 18 years. 56.2 % males. 3525 patients underwent coronary CT angiography (CCTA). 3250 patients underwent single photon emission tomography (SPECT). SPECT patients were mainly outpatients. CCTA patients also were almost exclusively outpatients. Thus, the population was generally a low-risk population. Among the CCTA patients, 1888 had a 0 CAC score. 175/1888 (9 %) had less than 70 % stenosis, while 41/1888 (2.2 %) had ≥70 % stenosis. Patients with ≥70 % stenosis: were younger 45 ± 12 yr versus 59 ± 11 yr, p < 0.001, predominantly males (51.2 % versus 38.8 % p < 0.001), had a slightly greater prevalence of family history of CAD (58.5 % vs 57.9 % p = 0.04), smoking history (68.3 % VS.44.6 % p < 0.001), hypertension (61 % versus 39.2 % p = 0.004), dyslipidemia (56.1 % versus 36.2 % p < 0.001), and obesity (70.7 % VS 11.7 % p < 0.001). 3250 patients had CAC and SPECT. Of these, 1161 had a zero CAC score. Of these 42 patients had significant ischemia >10 % of LV, Patients with ischemia >10 % of LV mass, and they were younger 44 ± 10 yr versus 60 ± 12 yr, p < 0.001, had a slightly greater prevalence of family history of CAD 61 % versus 57 % p = 0.07, smoking history (64.3 % versus 48.5 % p = 0.045), hypertension (69 % versus 45.5 % p = 0.003), obesity 19 % versus 11.7 %, and diabetes (35.7 % versus 14.5 % p < 0.001). A zero CAC does not rule out significant CAD in young adults with chest pain with CAD risk factors. These patients may need further investigations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".