Symptom status and non-calcified plaque burden across CAC strata: insights from AI-based CCTA quantification.
Level 4 - case-series / case-control
Retrospective cross-sectional comparative study
PubMed 41549194 · doi:10.1007/s10554-026-03624-w
What was done
A retrospective single-center study analyzed 1,835 adults (14% symptomatic, 86% asymptomatic) who underwent coronary CT angiography (CCTA) with AI-based plaque quantification. Participants were stratified into five coronary artery calcium (CAC) categories: 0, 1–99, 100–299, 300–1000, and >1000 Agatston units. Total non-calcified coronary plaque (NCP) volume was compared between symptomatic and asymptomatic patients within each stratum using non-parametric tests.
What was found
Median NCP volumes were similar between symptomatic and asymptomatic patients for CAC 0 (17.7 vs. 18.6 mm³, p = 0.96) and CAC 1–99 (50.8 vs. 56.3 mm³, p = 0.37). In the CAC 100–299 category, symptomatic patients had significantly higher median NCP volume (152.3 vs. 112.3 mm³, p = 0.035). No statistically significant differences were observed in CAC 300–1000 (p = 0.12) or CAC >1000 (p = 0.066).
Why it matters
This study indicates that symptom status may correspond with higher non-calcified plaque burden specifically in patients with intermediate CAC scores (100–299). It highlights a potential role for AI-based plaque quantification in refining risk assessment beyond standard calcium scoring.
Limits
The study is retrospective and limited to a single center. The sample had a large group imbalance (86% asymptomatic vs. 14% symptomatic), clinical outcomes were not tracked, and patient comorbidities or medication use were not reported in the abstract.
Cited by
- context A high coronary calcium score reflects stable calcified plaque but does not indicate whether soft plaque is present.