The presence, characterization and prognosis of coronary plaques among patients with zero coronary calcium scores

Abstract

Patients with coronary artery calcium (CAC) scores of zero are generally considered not to have atherosclerosis. Recent studies involving computed tomography coronary angiography (CTCA) challenge this assumption. This goal of the present study is to assess the frequency, morphology, location, and the prognosis of patients with plaque detected on CTCA and zero CAC. 1,119 patients (51 ± 12 years, 52% male) with a zero CAC score during CTCA study were retrospectively identified. The CTCA studies were assessed for the presence, morphology, location and severity of all coronary plaques. All-cause mortality was assessed. The prevalence of coronary plaque was 13% (147 patients). Among the 212 plaques identified 154 (73%) were non-calcified, 28 (13%) were calcified, and 30 (14%) were of mixed morphology. Notably, ≥70% stenosis was noted among only 0.4% of all patients. ROC analysis revealed that coronary artery disease risk factors did not add to the prediction of plaque among our patients. Over a mean follow-up of 2.5 ± 0.6 years there were 4 deaths (0.4%), all in patients without coronary plaque on CTCA. The presence of coronary plaque is not uncommon among patients with zero CAC scores. These plaques were rarely associated with hemodynamically significant stenoses and were associated with an excellent prognosis. Clinical factors do not appear to be useful in predicting which patients with zero CAC scores have undetected coronary plaque.

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

“…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]. Chen et al reported that age (>55 years) and BMI (>27) are independent factors associated with the presence of plaques [18].…”

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

“…In 2009, Budoff et al (11) reported that the prevalence of acute coronary syndrome was 0.4% in a patient population that was comprised of 25 253 cases with a CAC score of zero over a 12-year follow-up period. During a three-year follow-up of cases with a CAC score of zero, Uretsky et al (18) reported a mortality rate of 0.4%, and the deaths occurred among cases without plaques detected in coronary CT angiography. In 2010, Russo et al (5) found that the occurrence of cardiovascular events in cases with noncalcified or mixed type plaques was higher compared with cases that had a CAC score above 400.…”

“…Nikolaou et al (12) found that diabetes, hypertension, smoking, and obesity were significant risk factors, and diabetes and smoking were reported to be significant risks in studies by Budoff et al (11) and Blaha et al (19). 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.…”

Coronary artery calcium scoring and its impact on the clinical practice in the era of multidetector CT

“…However, according to the updated report by Uretsky et al [63], these soft plaques were rarely associated with hemodynamically significant stenosis and were associated with excellent prognosis. In addition, in the intermediate risk group, zero CACS was reported to exclude inducible ischemia in myocardial perfusion PET/CT [64].…”