Background: It is commonly assumed that the absence of coronary calcification makes the presence of obstructive coronary lesions highly unlikely. We evaluated the clinical characteristics of patients with at least one symptomatic, high-grade coronary artery stenosis both in computed tomography and invasive angiography but absence of any coronary calcification and compared the results to patients with stenoses in the setting of detectable coronary calcium.
Patients and methods: We retrospectively identified 21 consecutive symptomatic patients in whom a high grade coronary artery stenosis had been identified in 64-slice or Dual Source CT coronary angiography in the absence of coronary calcium and in whom that finding had been confirmed by invasive coronary angiography. We assessed clinical presentation, as well as standard cardiovascular risk factors and compared the results to 42 consecutive symptomatic patients in whom both coronary calcium and coronary stenoses had been identified in computed tomography and invasive coronary angiography.
Results: The majority of patients with coronary stenoses in the absence of coronary calcium presented with “unstable” symptoms (NSTEMI or unstable angina), significantly more frequently than patients with detectable calcification (71% vs. 26%, p = 0.001). The age range of patients without calcium was 33 to 76 years, their mean age was younger (53±13 vs. 63±8 years, p < 0.001).
Conclusion: The presence of significant coronary artery stenosis in the absence of coronary calcium is possible. It is more likely in the setting of unstable angina or NSTEMI than in stable chest pain and occurs more frequently in younger patients.
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