Coronary artery disease
Presence and Severity of Noncalcified Coronary Plaque on 64-Slice Computed Tomographic Coronary Angiography in Patients With Zero and Low Coronary Artery Calcium

https://doi.org/10.1016/j.amjcard.2006.12.026Get rights and content

How well absence of coronary artery calcium (CAC) predicts the absence of noncalcified coronary artery plaque (NCAP) has not been elucidated. We conducted a cross-sectional study of 554 outpatients to quantify NCAP prevalence as a function of CAC score. All patients underwent CAC scoring followed by 64-slice computed tomographic coronary angiography. Patients were categorized as having 0 CAC (416 patients) or low CAC (138 patients; men with CAC scores from 1 to 50 and women with scores from 1 to 10). Prevalence of detectable NCAP was 6.5% in patients with 0 CAC and 65.2% in those with low CAC. Compared with patients with 0 CAC, those with low CAC had markedly increased rates of NCAP occluding <50% of the arterial lumen (56.5% vs 6.0%, p <0.001) and ≥50% of the arterial lumen (8.7% vs 0.5%, p <0.001). In conclusion, in outpatients with a low to intermediate risk presentation and no known coronary artery disease, absence of CAC predicts low prevalence of any NCAP and very low prevalence of significantly occlusive NCAP. Low but detectable CAC scores are significantly less reliable in predicting plaque burden due to their association with high overall NCAP prevalence and nearly a 10% rate of significantly occlusive NCAP.

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Methods

From January 1, 2005 to December 31, 2005, 1,009 consecutive patients underwent CAC scoring followed immediately by 64-slice CTCA at a Los Angeles metropolitan community medical center. At the time of imaging, a written questionnaire was used to record each patient’s medical history (coronary disease, diabetes, hypertension, hypercholesterolemia, smoking history, and family history), symptoms (chest pain and dyspnea), and medication use. Response rates were 78% (family history) to 90% (chest

Results

Of the 554 patients analyzed, 416 (241 men and 175 women) were classified as having 0 CAC, and 138 patients (117 men and 21 women) were classified as low CAC. Table 1 lists demographic characteristics of these patients. Women were older than men in the 2 groups and were more likely to be in the 0-CAC group (51% vs 38%). Patients in the low-CAC group were older and more likely to have traditional risk factors. Patients in the 0-CAC group were more likely to report chest pain. None of these

Discussion

Our study represents the largest reported experience to date with 64-slice CTCA in outpatients with 0 and low CAC and is the first study to report prevalence of detectable NCAP in this population. We believe that using 64-slice CTCA to quantify NCAP burden was acceptable for 2 reasons beyond its safety as a noninvasive test. First, CTCA has the capability to capture the early phases of atherosclerotic coronary disease, when sensitivity of conventional coronary angiography may be compromised by

Acknowledgment

We give sincere thanks to Karen I. Berliner, PhD, for providing research and statistical consultation and Gerald Friede, MS, for providing 64-slice CTCA imaging expertise.

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This study was funded internally by Westside Medical Imaging, Beverly Hills, California.

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