Clinical characteristics of patients with obstructive coronary lesions in the absence of coronary calcification: an evaluation by coronary CT angiography
Open accessAbstract
Background: Multidetector CT allows detection of coronary artery calcium and, after contrast injection, visualisation of the coronary artery lumen. It is commonly assumed that the absence of coronary calcification makes the presence of obstructive coronary lesions highly unlikely. This study evaluates the clinical characteristics of patients with at least one symptomatic, high-grade coronary artery stenosis in both computed tomography and invasive angiography but absence of any coronary calcification and compares the results with patients with stenoses in the setting of detectable coronary calcium Patients and methods: The study retrospectively identified 21 consecutive patients with symptoms in whom a high-grade coronary artery stenosis had been identified in 64-slice or dual-source CT coronary angiography (Siemens Sensation 64 or Siemens Definition, 120 kV, 50 to 85 ml of intravenous contrast at 5 ml/s) in the absence of coronary calcium and in whom that finding had been confirmed by invasive coronary angiography. Clinical presentation (“unstable”: all forms of acute coronary syndrome versus “stable”: stable chest pain or dyspnoea on exertion) and standard cardiovascular risk factors were assessed, and the results were compared with 42 consecutive patients with symptoms 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 (non-ST-segment elevation myocardial infarction (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 (SD 13) vs 63 (8) years, p<0.001), but none of the risk factors showed any significant difference compared with patients with calcification. 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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Significant stenosis without coronary calcium is more likely in unstable angina or NSTEMI than in stable chest pain, and occurs more frequently in younger patients.
“It is more likely in the setting of unstable angina or non-ST elevation myocardial infarction (NSTEMI) than in stable chest pain, and occurs more frequently in younger patients.155”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [155]
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European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
2016 European Guidelines on cardiovascular disease prevention in clinical practice
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Self-citation2013 ESC guidelines on the management of stable coronary artery disease
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- Authors
- Marwan, M., Ropers, D., Pflederer, T., Daniel, W. G., & Achenbach, S.
- Affiliations
- Universitätsklinikum Erlangen (DE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Corresponding author
- Marwan, M
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2009-04-22
- Volume
- 95
- Issue
- 13
- Pages
- 1056-1060
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2130985927
- Cited by
- 89
- References
- 26
- Citations by year
- 2024: 1 · 2023: 4 · 2021: 3 · 2019: 8 · 2018: 2 · 2017: 6 · 2016: 7 · 2015: 6 · 2014: 5 · 2013: 9 · 2012: 9
- FWCI
- 9.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Coronary Artery Anomalies
- Keywords
- coronary artery calcification, coronary artery stenosis, coronary CT angiography, non-ST-elevation myocardial infarction, unstable angina, stable chest pain, clinical features, cardiovascular risk factors, young patients
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Calcinosis, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Tomography, X-Ray Computed, Coronary Angiography, Coronary Stenosis
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