Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis

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Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis Kongkiat Chaikriangkrai, MD, Ghanshyam Palamaner Subash Shantha, MD, Hye Yeon Jhun, MD, Patompong Ungprasert, MD, Gardar Sigurdsson, MD, Faisal Nabi, MD, John J. Mahmarian, MD, Su Min Chang, MD Annals of Emergency Medicine Volume 68, Issue 6, Pages 659-670 (December 2016) DOI: 10.1016/j.annemergmed.2016.07.020 Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 1 Flowchart diagram of study inclusion. Annals of Emergency Medicine 2016 68, 659-670DOI: (10.1016/j.annemergmed.2016.07.020) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 2 A, Forest plot of all included studies (n=8) evaluating risk ratio of CACS=0 for MACEs compared with CACS greater than 0. B, Forest plot of all included studies (n=5) evaluating risk ratio of CACS=0 for all-cause death or nonfatal myocardial infarction compared with CACS greater than 0. Annals of Emergency Medicine 2016 68, 659-670DOI: (10.1016/j.annemergmed.2016.07.020) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 3 Meta-influence analysis of included studies evaluating prognostic value of zero CACS for A, MACEs (n=8) and B, all-cause death or nonfatal myocardial infarction (n=5). Annals of Emergency Medicine 2016 68, 659-670DOI: (10.1016/j.annemergmed.2016.07.020) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 4 Summary receiver operating characteristic curve (solid line) with 95% CI (broken lines) of all included studies (n=8), with area under the curve of 0.80. Heterogeneity was observed in 2 studies with predominantly black patients (Chang et al11 and McLaughlin17). Annals of Emergency Medicine 2016 68, 659-670DOI: (10.1016/j.annemergmed.2016.07.020) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 5 Prognostic accuracy indices of CACS (0, >0) for cardiovascular events among included studies with predominantly white patients (6 studies, 2,432 patients). Annals of Emergency Medicine 2016 68, 659-670DOI: (10.1016/j.annemergmed.2016.07.020) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 6 Publication bias assessment by funnel plot of the included studies (n=8; white circles) with imputed studies (n=2; black circles) by trim-and-fill analysis. The white and black rhombuses represent the pooled-effect estimates with CI before and after trim-and-fill analysis. Annals of Emergency Medicine 2016 68, 659-670DOI: (10.1016/j.annemergmed.2016.07.020) Copyright © 2016 American College of Emergency Physicians Terms and Conditions