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Published on: September 22, 2023
The Atherosclerosis Profile by Coronary Computed Tomography Angiography (CTA) in Symptomatic Patients with Coronary
Gudrun Feuchtner1, Christoph Beyer1, Fabian Barbieri2
1Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
Insights
Coronary artery calcium score of 0 does not rule out coronary artery disease in symptomatic patients. Non-obstructive disease with high-risk plaque features is common, necessitating further plaque analysis for preventive measures.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Debate exists on excluding coronary artery disease (CAD) in symptomatic patients with a coronary artery calcium score (CACS) of 0.
- Coronary computed tomography angiography (CCTA) with high-risk plaque (HRP) feature analysis is increasingly used.
Purpose of the Study:
- To compare CCTA findings, including HRP features, in symptomatic patients presenting with a CACS of 0.
- To evaluate the prevalence and characteristics of CAD in this patient cohort.
Main Methods:
- 1709 symptomatic patients referred for CCTA were analyzed.
- Coronary artery calcium score (CACS), coronary stenosis (CADRADS), and HRP features (e.g., low-attenuation plaque, positive remodeling) were assessed.
- A subgroup of 665 patients with CACS 0 was specifically evaluated.
Main Results:
- In the CACS 0 cohort (n=665), 15.4% had CAD, predominantly non-obstructive (<50% stenosis).
- Obstructive CAD (>70% stenosis) was rare (0.61%).
- Over half (50.4%) of patients with non-obstructive CAD exhibited at least one HRP feature.
Conclusions:
- A CACS of 0 is insufficient to exclude non-obstructive CAD in symptomatic individuals.
- Non-obstructive CAD with HRP features is prevalent, indicating a need for primary preventive strategies.
- Quantitative plaque analysis is crucial for identifying at-risk patients even with a null CACS.
Abstract:
(1) Background: Whether it is safe to exclude coronary artery disease (CAD) in symptomatic patients with coronary artery calcium score (CACS 0), is an open debate. To compare coronary CTA including high-risk plaque (HRP) features in symptomatic patients with CACS 0 (2) Methods: 1709 symptomatic patients (age, mean 57.5 ± 16 years, 39.6% females) referred to coronary CTA for clinical indications were included. CACS, coronary stenosis (CADRADS) severity and HRP features (low-attenuation-plaque, spotty calcification, positive remodeling, NRS) were recorded. (3) Results: Of 1709 patients, 665 with CACS 0 were finally included. 562 (84.5%) had no CAD by CTA while 103 of 665 (15.4%) had CAD. Stenosis was minimal <25% in 79, mild <50% in 20, moderate in 1 and severe >70% in 3 patients. The rate of obstructive CAD was low with 4/665 (0.61%). The majority of patients had non-obstructive CAD (<50% stenosis) (99/103; 96.1%). A high proportion of patients with non-obstructive CAD had at least one HRP (52/103; 50.4%) per patient. (4) Conclusions: The rate of obstructive CAD is very low in symptomatic patients with CACS 0, and non-obstructive CAD domineering. CACS 0 does not rule out non-obstructive CAD and misses patients in which primary preventive measures are indicated. More than half of patients with non-obstructive CAD had high-risk plaque, highlighting the importance of quantitative plaque analysis.
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