Does Sex or Age Impact the Prognostic Value of a Zero Coronary Artery Calcium Score?

<b>Background:</b> It is unclear whether sex or age impacts the prognostic value of a zero coronary artery calcium (CAC) score. <b>Methods</b>: We searched our electronic medical record (eMR) database for primary prevention patients who underwent positron emission tomography/computed tomography (PET/CT) stress testing. We assessed coronary prognosis and all-cause death during 2.2 (SD 1.9) years of follow-up in women vs. men and in those ≥65 vs. <65 years old by CAC = 0 vs. CAC > 0 scores. <b>Results</b>: We identified 40,018 qualifying patients, of which 48.7% were women and 58.9% were ≥65. CAC = 0 was present in 7967 (19.9%), of which 67.8% were women, and 34.9% were aged ≥65. In CAC = 0 patients, 13 coronary events occurred: 7 (0.13%) in women and 6 (0.24%) in men (<i>p</i> = 0.28); and 6 (0.12%) in <65 and 7 (0.25%) in ≥65 years old (<i>p</i> = 0.15). All-cause death rates comparing CAC = 0 to CAC > 0 subjects were 3.1% vs. 9.8% overall: 3.1% vs. 9.5% in women and 3.3% vs. 10.2% in men, 2.4% vs. 6.9% for ages <65, and 4.7% vs. 11.5% for ≥65 years old; all <i>p</i> < 0.001. <b>Conclusions</b>: A zero CAC score predicts an excellent prognosis for not only coronary events but also all-cause mortality, both overall and in women and the elderly.