Skip to main navigation menu Skip to main content Skip to site footer
Brazilian Journal of Clinical Medicine and Review

Original research

Vol. 1 No. 3 (2023): July/September - 2023

Prevalence of coronary artery stenosis on computed tomography angiography of the coronary arteries in stable patients with zero coronary calcium score in Angola

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2023.1.3.19-27
Submitted
May 12, 2023
Published
2023-06-05

Abstract

Coronary artery calcium is a component of atherosclerosis and a marker for the presence of coronary artery disease (CAD). It can be quantified based on non-contrast computed tomography (CT) using coronary calcium score (CCS) according to the Agatston method. This study aimed to assess the prevalence of CAD in a population with a zero CCS, using 64-slice CT in Angola. A total of 204 patients were included in the study. Of the total sample, 60.3% of the patients were male. The mean age was 56.46±9.19 years. The mean CCS of the cohort was 44.4±117(range, 0–889). Among 204 patients, CCS was zero in 136 (66.7%) patients, and 68 (33.3%) patients had a CCS ≥1. Compared to CCS ≥1, patients with CCS=0 were younger (age 54.7±9.3 years vs. 59.9±7.9 years, p <0.001) and the proportion of women was significantly higher (47.1% vs. 25.0%, p 0.002). Patients with CCS zero had also less history of diabetes mellitus, dyslipidemia, and smoking in the past. Of the 136 patients with CCS=0, one (0.7%) had obstructive CAD, and 16 (11.8%) had non-obstructive CAD. Our results suggest that the absence of calcium was associated with a very low probability of significant stenosis of the coronary arteries.

References

  1. Eggen DA, Strong JP, McGill HC Jr. Coronarycalcification. Relationship to clinically significant coronary lesions and race, sex, and topographic distribution. Circulation 1965 Dec;32(6):948-55. doi: 10.1161/01.cir.32.6.948.
  2. Koopman MY, Willemsen RTA, van der Harst P, van Bruggen R, Gratama JWC, Braam R, van Ooijen PMA, Doggen CJM, Dinant GJ, Kietselaer B, Vliegenthart R. The Diagnostic and Prognostic Value of CoronaryCalcium Scoring in Stable Chest Pain Patients: A Narrative Review. Rofo. 2022Mar;194(3):257-265. doi: 10.1055/a-1662-5711.
  3. Meyer M, Henzler T, Fink C, Vliegenthart R, Barraza JM Jr, Nance JW Jr, Apfaltrer P, Schoenberg SO, Wasser K. Impact of coronary calcium score on the prevalence of coronary artery stenosis on dual-source CT coronary angiography in caucasian patients with intermediate risk. Acad Radiol; 2012;19:1316–1323. doi:10.1016/j.acra.2012.06.006
  4. de Carvalho MS, de Araújo Gonçalves P, Garcia-Garcia HM, de Sousa PJ, Dores H, Ferreira A, Cardim N, Carmo MM, Aleixo A, Mendes M, Machado FP, Roquette J, Marques H. Prevalence and predictors of coronary artery disease in patients with a calcium score of zero. Int J Cardiovasc Imaging. 2013 Dec;29(8):1839-46. doi: 10.1007/s10554-013-0267-x. Epub 2013 Jul 26.
  5. Kwon SW, Kim YJ, Shim J, Sung JM, Han ME, Kang DW, Kim JY, Choi BW, Chang HJ.. Coronary Artery Calcium Scoring Does Not Add Prognostic Value to Standard 64-Section CT Angiography Protocol in Low-Risk Patients Suspected of Having Co-ronary Artery Disease. Radiology. 2011;259: 92–99
  6. Kim YJ, Hur J, Lee HJ, Chang HJ, Nam JE, Hong YJ, Kim HY, Lee JW, Choi BW. Meaning of zero coronary calcium score in symptomatic patients referred for coronary computed tomographic angiography. Eur Heart J Cardiovasc Imaging. 2012;13: 776–785. doi:10.1093/ehjci/jes060
  7. Villines TC, Hulten EA, Shaw LJ, Goyal M, Dunning A, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng VY, Chinnaiyan K, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Kaufmann P, Lin FY, Maffei E, Raff GL, Min JK; CONFIRM Registry Investigators.. Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed to-mography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An In-ternational Multicenter) registry. J Am Coll Cardiol 2011;58: 2533–2540. doi:10.1016/ j.jacc.2011.10.851 [CONFIRM]
  8. Gabriel FS, Gonçalves LFG, Melo EV, Sousa ACS, Pinto IMF, Santana SMM, Matos CJO, Souto MJS, Conceição FMDS, Oliveira JLM.Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography. Arq Bras Cardiol. 2018 May;110(5):420-427. doi: 10.5935/abc.20180063.
  9. Gottlieb I, Miller JM, Arbab-Zadeh A, Dewey M, Clouse ME, Sara L, Niinuma H, Bush DE, Paul N, Vavere AL, Texter J, Brinker J, Lima JA, Rochitte CE. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol. 2010;55:627–634. doi:10.1016/ j.jacc.2009.07.072
  10. Drosch T, Brodoefel H, Reimann A, Thomas C, Tsiflikas I, Heuschmid M, Schroeder S, Burgstahler C. Prevalence and clinical characteristics of symptomatic patients with obstructive coronary artery disease in the absence of coronary calcifications. Acad Radiol. 2010;17:1254–1258. doi:10.1016/j.acra. 2010.05.006
  11. Morais H, Lourenço P, Martins C, Cardona L, Gonçal-ves MAA. Additional value of the coronary calcium score to conventional cardiovascular risk factors in predicting significant coronary disease diagnosed by computed tomography angiography in Angola. Brazilian Journal of Case Reports. 2023 Apr-Jun;01(2):20-26.
  12. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–832.
  13. Cury, R.C.; Abbara, S.; Achenbach, S.; Agatston, A.; Berman, D.S.; Budoff, M.J.; Leipsic, J.A. CAD-RADS(TM) Coronary Artery Disease—Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomo-graphy (SCCT), the American College of Radiology (ACR) and the North American Society of Cardiovascular Imaging (NASCI). J. Cardiovasc. Comput. Tomogr. 2016;10:269–281
  14. Bom MJ, Van der Zee PM, Van der Zant FM, Knol RJ, Cornel JH. Independent prognostic value of coronary artery calcium score and coronary computed tomography angiography in an outpatient cohort of low to intermediate risk chest pain patients. Neth Heart J. 2016;24: 332–342. doi:10.1007/ s12471-016-0819-5
  15. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Kroft LJ, Boersma E, Pazhenkottil A, Valenta I, Pundziute G, de Roos A, van der Wall EE, Kaufmann PA, Bax JJ. Incremental prognostic value of multi-slice computed tomography coronary an-giography over coronary artery calcium scoring in patients with suspected coronary artery disease. Eur Heart J. 2009;30: 2622–2629. doi:10.1093/eurheartj/ ehp272
  16. Nicoll R, Wiklund U, Zhao Y, Diederichsen A, Mickley H, Ovrehus K, Zamorano P, Gueret P, Schmermund A, Maffei E, Cademartiri F, Budoff M, Henein M. The coronary calcium score is a more accurate predictor of significant coronary stenosis than conventional risk factors in symptomatic patients: Euro-CCAD study. Int J Cardiol. 2016;207: 13–19. doi:10.1016/j.ijcard.2016.01.056
  17. Akram K, O'Donnell RE, King S, Superko HR, Agatston A, Voros S. Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score. Atherosclerosis. 2009;203: 533–537. doi:10.1016/ j.atherosclerosis.2008.07.008
  18. van Werkhoven JM, de Boer SM, Schuijf JD, Cademartiri F, Maffei E, Jukema JW, Boogers MJ, Kroft LJ, de Roos A, Bax JJ. Impact of clinical presentation and pretest likelihood on the relation between calcium score and computed tomographic coronary angiography. Am J Cardiol. 2010;106:1675–1679. doi:10.1016/j.amjcard. 2010.08.014
  19. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. Circulation. 1995;92:2157–2162
  20. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, Liu K, Shea S, Szklo M, Bluemke DA, O'Leary DH, Tracy R, Watson K, Wong ND, Kronmal RA.Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–1345
  21. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O'Leary D, Carr JJ, Goff DC, Greenland P, Herrington DM. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308:788–795
  22. Wang X, Le EPV, Rajani NK, Hudson-Peacock NJ, Pavey H, Tarkin JM, Babar J, Williams MC, Gopalan D, Rudd JHF. A zero coronary artery calcium score in patients with stable chest pain is associated with a good prognosis, despite the risk of non-calcified plaques. Open Heart. 2019;6: e000945 doi:10.1136/openhrt-2018-000945
  23. Shareghi S, Ahmadi N, Young E, Gopal A, Liu ST, Budoff MJ. Prognostic significance of zero coronary calcium scores on cardiac computed tomography.J Cardiovasc Comput Tomogr. 2007 Dec;1(3):155-9. doi: 10.1016/j.jcct.2007.10.001.
  24. Ergün E, Koşar P, Oztürk C, Başbay E, Koç F, Koşar U. Prevalence and extent of coronary artery disease determined by 64-slice CTA in patients with zero coronarycalcium score. Int J Cardiovasc Imaging. 2011Mar;27(3):451-8. doi: 10.1007/s10554-010-9681-5. Epub 2010 Aug 24.
  25. Rubinshtein R, Gaspar T, Halon DA, Goldstein J, Peled N, Lewis BS. Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome. Am J Cardiol 2007;99:472– 475. doi:10.1016/j.amjcard.2006.08.060
  26. Feuchtner G, Beyer C, Barbieri F, Spitaler P, Dichtl W, Friedrich G, Widmann G, Plank F. The Atherosclerosis Profile by Coronary Computed Tomography Angiography (CTA) in Symptomatic Patients with Coronary Artery Calcium Score Zero. Diagnostics (Basel). 2022 Aug 24;12(9):2042. doi: 10.3390/diagnostics12092042.

Most read articles by the same author(s)