In our study, 245 patients with zero CS were selected.
Those patients with motion artifacts were completely excluded from our study.
- 115 (46.9%) patients had no disease with normal coronary vessels.
- 130 patients (53%) had an atherosclerotic disease
- 23 patients (9.3%) had significant coronary artery disease.
- 4.3% of the patient had obstructive coronary disease.
- 107 patients had nonsignificant coronary artery disease.
Fig. 1
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
Fig. 2
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
SIGNIFICANT DISEASE
- A significant disease is considered when the coronary artery stenosis is more than 50% (Figures 3,4,5).
- 23 patients had significant coronary stenosis, out of which 10 patients had >70% stenosis. Patients with severe CAD needed perfusion scans to exclude Myocardial infarction as a cause of pain.
- In the cases of more than 70% stenosis patients had to undergo conventional angiography and angioplasty for further management.
Fig. 3: A 60 years old male presenting with atypical chest pain shows nil calcium score Coronary angiography.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
Fig. 4: Coronary angiography of similar patient shows severe focal disease in LAD(left anterior descending artery).
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
Fig. 5: Coronary angiography axial image of proximal LAD shows severe diffuse disease and requires Perfusion scan to exclude MI.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
NON SIGNIFICANT CORONARY DISEASE :
- A nonsignificant disease is considered when coronary artery stenosis is less than 50%.
- 107 had non-significant (<50%) coronary stenosis.
Fig. 6: Coronary angiography show small non calcified plaque in proximal segment of LAD with focal mild stenosis(non significant).
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
SINGLE VESSEL DISEASE
In our study patients with zero CS and atypical chest pain,53% had atherosclerotic disease, with 4.7% having single-vessel disease.
Fig. 7: 3 D Coronary Reconstituted image showing stenosed LAD suggestive of significant single vessel disease.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
Fig. 8: Similar patient on conventional angiography showing severe narrowing at LAD(shown by arrow). He had Perfusion scan showing MI.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
DOUBLE AND TRIPPLE VESSEL DISEASE
In our reasearch, symptomatic patients with zero CS patients, 5.3% had double and Triple vessel disease.
Fig. 9: 3D Reconstituted image showing Double vessel disease with moderate stenosis of LAD and severe stenosis of Obtuse marginal artery.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
Fig. 10: 3D Reconstituted image of Coronary angiography showing moderate stenosis of LAD in a patient with double vessel disaese.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
Fig. 11: 3D Reconstituted image showig severe stenosis of Obtuse Marginal artery in a patient with double vessel disease.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
Fig. 12: Conventional angiography showing significant disease in LAD and Obtuse marginal artery.
References: Radiology Department,Rehman Medical Institute - Peshawar/PK
IMPORTANT NOTES
- A nil calcium score is not a guarantee that the vessel is free from atherosclerotic lesions, including vulnerable plaques.
- CT Coronary Angiography also tells about coronary veins and cardiac chambers, venous mapping, and detection of intracardiac thrombi. This technique can also be used to evaluate venous or arterial bypass grafts.
STUDY LIMITATION
- The possibility of false-positive and false-negative CCTA results was still there as Coronary artery disease was defined according to CCTA and not invasive coronary angiography.
- This study should be validated in a larger population with different ethnic groups as this was the other limitation of our study.