Prevalence of Non-calcified Coronary Plaque on 64-Slice Computed Tomography Coronary Angiography in Patients with Zero and Low Coronary Artery Calcium Scores
CWS Wan, A Li, OC Leung, YC Wong
Hong Kong J Radiol 2015;18:22-6
DOI: 10.12809/hkjr1414271
Objective: To study the prevalence of non-calcified plaque causing significant coronary artery stenosis in patients with zero or low coronary artery calcium scores in a regional hospital in Hong Kong.
Methods: Computed tomography reports and clinical records (at least 3 years after computed tomography coronary angiography) of 336 consecutive patients with coronary artery calcium scores and computed tomography coronary angiography performed with a 64-slice multi-detector computed tomography scanner from January 2007 to December 2008 were retrospectively reviewed. Patients with zero and low coronary artery calcium scores were analysed for prevalence of atherosclerotic plaque and degree of arterial luminal stenosis.
Results: The records of 194 patients with zero (n = 130; 67.0%) and low (n = 64; 33.0%) coronary artery calcium scores were included. Non-calcified plaque was found in 20 (15.4%) patients with zero coronary artery calcium score and 49 (76.6%) patients with low coronary artery calcium score. Significant coronary artery stenosis (>50% luminal diameter stenosis) by non-calcified plaque was found in five (3.8%) patients with zero coronary artery calcium score and 18 (28.1%) patients with low coronary artery calcium score. Subsequent cardiac catheterization was performed in three patients with zero coronary artery calcium score (mean follow-up, 34.5 months; standard deviation, 6.3 months); the result was in agreement with computed tomography coronary angiography for one patient and two had overestimation of stenosis. Subsequent cardiac catheterizations were performed in 11 patients with low coronary artery calcium score; the results were in agreement with computed tomography coronary angiography for 10 patients and one had overestimation of stenosis.
Conclusions: Absence of coronary artery calcium does not exclude obstructive coronary artery disease. Low coronary artery calcium score is not reliable in predicting non-calcified plaque burden.
中文摘要
64排CT冠狀動脈造影觀察冠狀動脈鈣化積分為零和低值的患者中非鈣化斑塊發生率
溫詠雪、李子飛、梁安祥、王耀忠
目的：探討香港一所分區醫院內冠狀動脈鈣化（CAC）積分為零和低值的患者中致冠脈狹窄的非鈣化斑塊的發病率。
方法：回顧2007至2008年期間連續336名接受64層多排螺旋CT冠狀動脈造影的病人的CT報告和臨床紀錄（冠狀動脈造影後至少3年）。分析了CAC積分為零和低值的患者動脈粥樣硬化斑塊的發生率和動脈管腔狹窄程度。
結果：共分析了194名病人的紀錄，當中包括130名（67.0%）CAC積分為零和64名（33.0%）低CAC積分的患者。CAC為零和低值的病人中，分別有20人（15.4%）和49人（76.6%）有非鈣化斑塊；另外分別有5人（3.8%）和18人（28.1%）出現顯著的冠狀動脈狹窄（多於50%管腔直徑狹窄）。CAC積分為零的病人中，最終3人接受心導管檢查（平均隨訪期為34.5個月；標準差6.3個月）；其中1人結果與CT冠狀動脈成像一致，但其餘2人均高估了狹窄程度。低CAC積分的病人中，最終11人接受心導管檢查；其中10人結果與CT冠狀動脈成像一致，其餘1人被高估了狹窄程度。
結論：冠狀動脈無鈣化並不能排除阻塞性冠狀動脈疾病。低CAC積分並不能可靠地預測非鈣化斑塊的狀況。