Abstract
Background: Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Methods and Results: We assessed independent predictors of the presence and number of segments with NCP in 111 Japanese patients with zero CACS who underwent 64-slice multi-detector computed tomography at our hospital. Thirty five patients (32%) had NCP, and 24 patients (22%) had ≥ 2 NCPs. Multiple logistic regression analysis revealed that significant predictors for the presence of NCP were age (odds ratio [OR]: 1.06, 95% confidence interval [CI] 1.01 - 1.11, p = 0.021), male (OR: 3.61, 95% CI 1.40 - 9.35, p = 0.008) and diabetes mellitus (OR: 3.10, 95% CI 1.02 - 9.45, p = 0.046), and those for the presence of ≥ 2 NCPs were age (OR: 1.08, 95% CI 1.02 - 1.15, p = 0.007) and a current smoking habit (OR: 5.09, 95% CI 1.00 - 25.74, p = 0.049). Multiple linear regression analysis identified advanced age, male gender and diabetes mellitus as independent predictors of the number of NCPs. A novel score calculated from the above four predictors showed moderate accuracy for a diagnosis of NCP and ≥ 2 NCPs, with areas under receiver operating curves of 0.738 and 0.736, respectively. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs.
Highlights
Coronary artery calcium score (CACS) is useful for the risk stratification of coronary artery disease, and zero calcium scores (CACS) is associated with a very low likelihood of coronary artery plaque and future cardiac events [1,2]
Zero CACS has been associated with a very low likelihood having of coronary artery plaque and significant coronary artery disease (CAD), as well as a minimal risk of future cardiovascular events [1,2], recent reports have indicated that some patients with zero CACS do have noncalcified coronary plaques (NCP) or significant coronary artery stenosis
We found that advanced age, male gender, diabetes mellitus (DM) and current smoking were independent predictors of the presence of NCPs in patients with zero CACS
Summary
Coronary artery calcium score (CACS) is useful for the risk stratification of coronary artery disease, and zero CACS is associated with a very low likelihood of coronary artery plaque and future cardiac events [1,2]. The recent technical development of multi-detector computed tomography (MDCT) has rendered it feasible to calculate CACS and to detect coronary artery plaque or obstructive coronary lesions using CT coronary angiography (CT CA). The presence of obstructive coronary lesions, noncalcified coronary plaque (NCP) or the number of coronary plaques detected by CTCA improves the prediction of cardiac events over and above conventional risk scores and CACS [3,4,5,6]. Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs
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