The presence, characterization and prognosis of coronary plaques among patients with zero coronary calcium scores.
Level 3 - non-randomized controlled study
Retrospective multicenter cohort study evaluating plaque characteristics and prognostic follow-up in patients with zero CAC.
PubMed 20967569 · doi:10.1007/s10554-010-9730-0
What was done
A retrospective multicenter study evaluated 1,119 patients (mean age 51 ± 12 years, 52% male) who had a zero coronary artery calcium (CAC) score during computed tomography coronary angiography (CTCA). CTCA scans were analyzed for coronary plaque presence, morphology, location, and severity. Risk factor predictive value was evaluated using ROC analysis, and all-cause mortality was tracked over a mean follow-up of 2.5 ± 0.6 years.
What was found
Coronary plaque was present in 13% of patients (147 individuals). Among the 212 plaques identified, 73% (154) were non-calcified, 14% (30) were mixed morphology, and 13% (28) were calcified. Stenosis ≥70% occurred in 0.4% of patients. Coronary artery disease risk factors did not add to plaque prediction on ROC analysis. During follow-up, 4 deaths (0.4%) occurred, all in patients without CTCA-detected plaque.
Why it matters
While plaque is present in approximately one in eight patients with a zero calcium score, significant stenosis is rare and short-term prognosis remains excellent.
Limits
Retrospective observational design subject to selection bias. Follow-up was limited to 2.5 years with only 4 deaths, providing insufficient statistical power for mortality comparisons. Non-fatal cardiovascular events were not reported.
Cited by
- supports Coronary artery calcium (CAC) scoring only detects calcified arterial plaque and cannot identify soft (non-calcified) plaque.