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. 2024 Feb 5;29(5):102233.
doi: 10.1016/j.jaccas.2024.102233. eCollection 2024 Mar 6.

The Zero Calcium Score Paradox

Rachad Ghazal  1 , Danish Bawa  1 , Adnan Ahmed  1 , Dhanunjaya Lakkireddy  1 , Vasvi Singh  2
Affiliations

The Zero Calcium Score Paradox

Rachad Ghazal et al. JACC Case Rep. .

Abstract

Our study presents a case of angina with a zero calcium score yet severe coronary stenosis from noncalcified plaque. We highlight the limitation of otherwise prognostically powerful coronary calcium score as a singular predictive tool especially when used in symptomatic patients.

Keywords: CTA coronary angiography; arterial plaque; coronary artery calcium score; coronary artery disease; coronary atherosclerosis; coronary calcification.

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Conflict of interest statement

Dr Singh has received research funding from the American Society of Nuclear Cardiology and Pfizer; and has served on Pfizer’s Speakers Bureau and Advisory Committee. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Excellent Correlation Between Coronary Computed Tomography Angiography and Invasive Coronary Angiography in a High-Risk Symptomatic Patient With Noncalcified Plaque Causing Severe Stenosis in the Right Coronary Artery Coronary computed tomography angiography (A, B), 3-dimensional volume rendering (C), and Fractional flow reserve computed tomography (D) demonstrating noncalcified plaque (yellow arrows) involving a discrete segment of the mid to distal right coronary artery within the posterior right atrioventricular groove, causing severe stenosis (70%-99%). Coronary angiography images showing pre- (E) and post- (F) percutaneous transluminal coronary angioplasty of right main coronary artery along with a drug-eluting stent.
See this image and copyright information in PMC

References

    1. Nasir K., Cainzos-Achirica M. Role of coronary artery calcium score in the primary prevention of cardiovascular disease. BMJ. 2021;373:n776. - PubMed
    1. Mortensen M.B., Gaur S., Frimmer A., et al. Association of age with the diagnostic value of coronary artery calcium score for ruling out coronary stenosis in symptomatic patients. JAMA Cardiol. 2022;7(1):36–44. - PMC - PubMed
    1. Sama C, Abdelhaleem A, Velu D, et al. Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: a systematic review and meta-analysis. J Cardiovasc Comput Tomogr. Published online October 9, 2023. https://doi.org/10.1016/j.jcct.2023.10.002 - DOI - PubMed

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