Keywords:
Cardiac, Arteries / Aorta, Cardiovascular system, CAD, CT, CT-Angiography, Angioplasty, Audit and standards, Acute, Arteriosclerosis, Image registration, Prospective, Observational, Performed at one institution
Authors:
S. Alam, U. S. Umer, S. Gul, S. Ghulam ghaus, S. Iqbal, A. Nawaz Khan, H. Abid; peshawar/PK
DOI:
10.26044/ecr2020/C-10256
Purpose
AIMS AND OBJECTIVES:
Over decade multi-slice Computed tomography has become an important technique for diagnosing atherosclerosis and evaluating stenosis of the coronary arteries. It is of great help in a patient with suspected acute coronary syndrome presenting in the emergency deparment[1].
Coronary CT angiography (CTA) is an emerging noninvasive technique that can evaluate both calcified and noncalcified plaque[2]. The detection of noncalcified plaques is very important to be diagnosed early so initial therapeutic management can be started early[2]. Calcific plaques are more resistant to therapeutic interventions[3]. Coronary artery calcification is highly specific for atherosclerosis and is likely due to the healing mechanism of subclinical plaque rupture events[4]. A strong correlation exists between coronary calcium score and coronary artery disease[5]. Coronary artery calcification quantification is a marvelous tool to measure atherosclerotic plaque burden and is found to be the most predictive cardiovascular risk marker in asymptomatic patients[6].
The latest ACCF/AHA Expert Consensus Documents state that for the symptomatic patient, exclusion of measurable coronary calcium should be diagnostic criterion before doing invasive diagnostic procedures[7,8]. Several recent studies[4,9,10]reported that a CCS of zero does not exclude obstructive CAD among patients with a high suspicion of CAD referred for coronary angiography or patients with atypical chest pain[4]. Zero Calcium score group of people can have increased chances of multivessel disease[5]. The absence of CAC reduces but does not fully eliminate the occurrence of obstructive CAD[10].
Myocardial Infarction is a leading cause of death in developing countries[11]. Patients without detectable calcium have a very low rate of coronary artery disease death or MI (0.4%) over three to five years of observation[9]. The identification of reversible myocardial dysfunction is an important finding in a patient with CAD on Myocardial perfusion scan. So early diagnosis of CAD[11] can help save the patient life.
Our aim is to emphasize the importance that calcium scoring is an important criterion for measuring coronary artery disease but just depending on calcium score can underestimate noncalcified atheromatous plaques and resultant atherosclerotic disease.