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Updated: Jul 15, 2026

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Differences in plaque composition and distribution in stable coronary artery disease versus acute coronary syndromes;
J D Schuijf1, T Beck, C Burgstahler
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Background:
Plaque composition rather than degree of luminal narrowing may be predictive of acute coronary syndromes (ACS). The purpose of the study was to compare plaque composition and distribution with multi-slice computed tomography (MSCT) between patients presenting with either stable coronary artery disease (CAD) or ACS.
Methods:
MSCT was performed in 22 and 24 patients presenting with ACS or stable CAD, respectively. Coronary lesions were classified as calcified, non-calcified or mixed while signal intensity (SI) was measured.
Results:
In patients with stable CAD, the majority of lesions were calcified (89%). In patients with ACS, less calcifications were observed with a greater proportion of non-calcified (18%) or mixed (36%) lesions (P<0.001). Accordingly, mean SI of plaques was significantly less in ACS (320+/-201 HU versus 620+/-256 HU in stable CAD, P<0.001). Dividing lesions in the ACS group according to culprit versus non-culprit vessel location resulted in no significant difference in average SI between these two groups while still lower as compared to stable CAD (P<0.001).
Conclusions:
In patients with ACS, significantly less calcifications were present as compared to stable CAD. Moreover, even in non-culprit vessels, multiple non-calcified plaques were detected, indicating diffuse rather than focal atherosclerosis in ACS.
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