Introduction Atheromatous plaque rupture is the most common cause of coronary artery thrombosis. Non-calcified plaques, with thin fibrous cap and large thrombogenic lipid core, are predominantly the most susceptible to rupture.
Aims To investigate, with a 640-slice, 320-row CT scanner, the non-calcified coronary artery plaques (NCAP) prevalence and the degree of caused obstruction, in a cohort of symptomatic subjects, without coronary calcification.
Methods and Results Out of 1806 patients, who underwent coronary CT angiography (CTCA), we retrospectively identified 447 symptomatic patients with coronary artery calcification (CAC) score of 0. Standard cardiovascular risk factors were assessed prior to the CTCA study. From the 447 subjects, 400 (89.48%) had a negative CTCA, while in 47 (10.51%) NCAP were depicted on CTCA. Four of these (4/47) had stenosis more than 50%. Mean age of patients with positive CTCA was 56.21 years, significantly higher than those of patients with negative CTCA (50.6 years, p<0.004). Additionally, when compared to patients with normal CTCA, those with NCAP were in higher risk of developing CAD, as derived from the pre CTCA assessment (26% vs 34.04%, p<0.0001). The Left Anterior Descending artery (LAD), and especially the proximal segment, was the predominant location for the development of NCAP.
Conclusion Absence of coronary calcification does not exclude the presence of atherosclerosis; NCAP is present in up to 10% of patients with CAC score of 0. Symptomatic patients, who older in age, with multiple factors and high probability of CAD, would benefit from CTCA even in the absence of CAC.
- Coronary calcium score zero
- non-calcified plaque
- cardiovascular risk factors
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