The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography
Ilan Gottlieb, MD ,#,
Julie M. Miller, MD,
Armin Arbab-Zadeh, MD,
Marc Dewey, MD ,
Melvin E. Clouse, MD¶,
Leonardo Sara, MD*,
Hiroyuki Niinuma, MD ,
David E. Bush, MD,
Narinder Paul, MD||,
Andrea L. Vavere, PhD,
John Texter, PA-C,
Jeffery Brinker, MD,
João A.C. Lima, MD and
Carlos E. Rochitte, MD*,*
* Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
Johns Hopkins University School of Medicine, Baltimore, Maryland
Charité Medical School, Humboldt, Universität zu Berlin and Freie Universität zu Berlin, Berlin, Germany
Iwate Medical University, Morioka, Japan
|| Toronto General Hospital, Toronto, Ontario, Canada
¶ Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
# UFRJ, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Figure 2 Individual Values of CS and Maximum Coronary Stenosis in Subjects
Linear regression plot showing the poor correlation between the maximum degree of coronary stenosis by conventional coronary angiogram (CCA) and the calcium score (CS) in a patient.
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Figure 3 Prevalence of Obstructive CAD and Need for Clinically Indicated Revascularization Among Patients in Different CS Categories
As the CS increases, the prevalence of obstructive coronary artery disease (CAD) and revascularization also increase (p < 0.001 for all trends). Note that the group of 0 CS patients has high prevalence of obstructive CAD and revascularization. The blue bars indicate CCA  50%; the red bars indicate CCA 70%; and the green bars indicate revascularization. Abbreviations as in Figure 2.
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Figure 4 A Patient From Our Study
Example of an outpatient 53-year-old man with 0 calcium score and severe stenosis on the midportion of the left descending coronary (arrows), as can be seen on the conventional angiogram (A), on the multiplanar reformatted image (B), and on the 3-dimensional volume rendered image (C) from coronary computed tomography angiogram. The stenosis also extends to a diagonal branch, as can be seen in A and C.
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