Preliminary Observations on Discordance Between Coronary Artery Calcium Score of Zero and Coronary Computed Tomography Angiography Findings in Asymptomatic Adults.
Level 4 - case-series / case-control
Small cross-sectional diagnostic case series
PubMed 41488027 · doi:10.14740/cr2151
What was done
Eighteen asymptomatic adults (mean age 51.4 ± 10.6 years, 88.8% male) with cardiovascular risk factors and a coronary artery calcium (CAC) score of 0 underwent coronary computed tomography angiography (CCTA) to assess for subclinical coronary artery disease (CAD). Diagnostic agreement between CAC and CCTA was evaluated using the Wilcoxon signed-rank test, alongside assessment of clinical and biochemical risk factors.
What was found
Despite a CAC score of 0, CCTA revealed CAD in 72.2% (13 of 18) of participants (Wilcoxon Z = -3.606, P < 0.001), identifying non-calcified plaques missed by CAC. The cohort had high rates of smoking (70.5%), family history of CAD (56.25%), and a mean BMI of 27.7 ± 3.6 kg/m². Elevated cardiac and inflammatory markers (high-sensitivity cardiac troponin T, apoB, and Lp(a)) were observed in participants with positive CCTA findings, though specific numeric values for these markers were not reported in the abstract.
Why it matters
This study highlights that a CAC score of zero does not completely rule out subclinical, non-calcified coronary atherosclerosis in asymptomatic individuals with risk factors.
Limits
The sample size is extremely small (n = 18) and heavily male-skewed (88.8%). As a cross-sectional preliminary observation, it lacked clinical follow-up for hard cardiovascular outcomes, and the degree of luminal stenosis was not specified in the abstract.
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- supports A coronary artery calcium score does not detect non-calcified soft plaque.