C68. Patient with Zero Coronary Calcium Score and Significant Stenosis in Left Anterior Descending Coronary Artery: a case report

Abstract

Abstract Background Coronary heart disease is pathological process characterized by the accumulation of atherosclerotic plaque in the epicardial artery, either obstructive or non-obstructive. Coronary calcium score (CCS) detects and calculates coronary artery calcification (CAC) and CT coronary angiography (CTCA) allows evaluation of the coronary arteries anatomy for luminal stenosis due to atherosclerotic plaque with or without calcification. Case Description A 70 years-old man, admitted to the emergency department with a chief complain of chest pain. Physical examination was within normal limits. His treadmill stress testing was positive ischemic response one month prior. Then patient undergoing CTCA, the result was zero calcium score with 90-99% stenosis at proximal left anterior descending (LAD) due to soft plaque. Invasive coronary angiography (ICA) confirmed the CT findings and showed total occlusion with grade V thrombus in osteal LAD. Discussion A study showed that 1-2% of symptomatic patients with zero CAC potentially had obstructive CAD. It is supported with this report that the patient had typical chest pain with zero calcium score. CCTA has high sensitivity and negative predictive value for the detection of CAD but has a relatively low positive predictive value, especially for moderate severity coronary. In this report CTCA showed 90% -99% stenosis at the proximal LAD and correlate with ICA findings.