Outcome of sedentary patients: does the power of zero cac make a difference?

Coronary artery calcium score (CACS) and exercise capacity (EC) are both independent prognostic tests in coronary artery disease (CAD).

We aimed to assess the incremental prognostic role of EC to CACS, particularly in those with absent or low coronary calcification.

The cohort consisted of patients who had clinically indicated exercise stress testing and CACS assessment with a median of 27 days of each other. EC was defined based on peak metabolic equivalents (METS) achieved during exercise stress test. CACS was determined using the Agatston method. Patients were followed from the latest test date to incident MACE (inclusive of all-cause death, non-fatal myocardial infarction, late revascularization and admission for heart failure).

There were a total of 1932 patients in the study population (mean age 56±12, 42% female, 48% hypertension, 21% diabetes, 48% dyslipidemia). Peak METS <6 was achieved in 8% of patients, and the median (IQR) CACS was 9 (0–203). Patients with EC <6 METS had doubling of their event rate across strata of CACS, even amongst patients with absent or low coronary calcifications (CACS 0: 4.6 vs 10.9; CACS 1–99: 10.4 vs 20.4; MACE per 1000 person year in patients with peak METS ≥ vs <6 respectively) (Figure 1).

Our findings showed that poor exercise capacity was associated with higher risk even in patients with absent or low coronary calcification.

Type of funding sources: None.