Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 37821352 · doi:10.1016/j.jcct.2023.10.002
What was done
A systematic review and random-effects meta-analysis of studies indexed in PubMed/Medline and Web of Science (inception to March 31, 2023) evaluating asymptomatic patients with a coronary artery calcium score (CACS) of zero. The authors evaluated the prevalence and severity of non-calcified coronary plaques (NCP) identified by coronary CT angiography (CCTA) and analyzed associated clinical predictors. Heterogeneity was evaluated with I² statistics, and publication bias was assessed using funnel plots and Egger's test.
What was found
Across 14 studies with 37,808 patients, the pooled prevalence of any NCP was 10% (95% CI: 6% to 13%). The pooled prevalence of obstructive NCP across 10 studies (21,531 patients) was 1.1% (95% CI: 0.7% to 1.5%). Male sex was the strongest clinical predictor of any NCP (OR 3.22, 95% CI: 2.17 to 4.27), along with diabetes mellitus (OR 1.69, 95% CI: 1.41 to 1.97) and hypertension (OR 1.46, 95% CI: 1.31 to 1.62).
Why it matters
These findings confirm that clinically significant or obstructive coronary disease is rare in asymptomatic individuals with zero CAC, cautioning against routine CCTA use in this population while identifying specific subgroups (e.g., diabetic or hypertensive males) at higher risk of occult plaque.
Limits
The abstract does not disclose specific heterogeneity (I²) values, risk of bias assessments of the included studies, or whether findings differed by imaging protocols. Downstream clinical cardiovascular outcomes and event rates associated with these non-calcified plaques were not reported.
Cited by
- supports Coronary artery calcium scores reflect only hardened, calcified plaque and do not detect soft arterial plaque.