Prevalence and extent of coronary artery disease determined by 64-slice CTA in patients with zero coronary calcium score

Abstract

The purpose of the study was to assess the presence and extent of atherosclerosis determined by 64-slice CTA in patients with 0 coronary calcium score (CACS) and to evaluate the affect of demographic features and risk factors on the atheroma burden of these patients. 883 cases (378 (42.8%) male, 505 (57.2%) female, mean age 51.28) with zero CACS were included in the study. Cases underwent CTA because of carrying risk factors or having chest pain or atypical symptoms. A non-enhanced CT scan was obtained for calcium scoring immediately before CTA in all cases. CT examinations were performed by 64-slice scanner (Toshiba, Aquillon 64, Toshiba Medical Systems, Otowara, Japan). Coronary artery disease (CAD) was graded according to CTA findings and five groups were defined. In 703 cases (79.6%) CTA was normal while 180 (20.4%) cases had positive CTA findings and 43 cases (4.9%) had CTA obstructive lesion. Cases with positive CTA findings were significantly older than those with normal CTA Diabetes was a significant risk factor of CAD in both male and female cases. Dyslipidemia was associated with CAD in males and family history of CAD was a significant risk factor for females with positive CTA findings. This study demonstrated that considerable amount of patients with zero CAC score have positive CTA findings. Age and diabetes are the risk factors, which were associated with positive CTA findings in both sexes. Dyslipidemia was a significant risk factor in males and family history of CAD in females. Especially in patients with risk factors CTA is better than CAC scoring in determining the atheroma burden.

Frequency and extent of coronary atherosclerotic plaques in patients with zero coronary artery calcium score: assessment with computed tomographic angiography

“…Similarly, Kelly et al (14) and Ergün et al (13) found that the mean age of the cases with atherosclerotic plaque, as detected by coronary CT angiography (53 and 54.4 years, respectively), was higher than the mean age of the cases (49 and 50.4 years, respectively). The mean age of the cases with atherosclerotic plaques that caused significant stenosis, as detected by coronary CT angiography, was 54 years according to Kelly et al (14) and 55.2 years according to Ergün et al (13); however, we found that the mean age of these cases was 53.8 years in our study.…”

“…In a study by Akram et al (15), the rate of obstructive plaques in symptomatic patients with a CAC score of zero was 8.2%, whereas obstructive plaques were not detected in asymptomatic patients. However, Kelly et al (14) and Ergün et al (13) did not find a correlation between symptoms and obstructive and nonobstructive lesions. In our study, we did not find a correlation between the presence of noncalcified atherosclerotic plaques that were detected using coronary CT angiography in a symptomatic patient population with a CAC score of zero.…”

“…In our study, we observed that noncalcified plaques caused nonsignificant stenoses (<50%) in 15.3% of the patients with a CAC score of zero and significant stenoses (≥50%) in 2.1% of these patients. The presence of noncalcified plaques in cases with a CAC score of zero has been reported at varying frequencies in the literature (1,7,8,13,14). These rates were reported to be 6.5% by Cheng et al (7) (14) reported a rate as high as 51%.…”

“…Uretsky et al (18) reported that the male gender, age, and smoking were risk factors, whereas Ueda et al (20) reported that diabetes and hypercholesterolemia were risk factors. Ergün et al (13) reported that age and diabetes were risk factors for both genders, whereas dyslipidemia was a risk factor for male patients, and family history was a risk factor for female patients. Rivera et al (10) found that significant risk factors were the male gender and age for calcified and mixed type plaques; the male gender, diabetes, and smoking were risk factors for noncalcified plaques; and high LDL cholesterol was a risk factor for mixed type plaques.…”

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

“…Predictive factors for the presence of NCP in patients with zero CACS have also been described in several articles. Ergün et al reported that age and DM are associated with positive CTCA findings [14]. Uretsky et al reported that age (>60 years), male gender and a current smoking history are associated with a greater tendency to have coronary plaque [15].…”