Stenosis Can Still Exist in Absence of Coronary Calcium

Study challenges AHA guidelines advising use of coronary calcium to assess need for intervention
By Jeff Muise
HealthDay Reporter

FRIDAY, Feb. 12 (HealthDay News) -- In contradiction of professional guidelines, the absence of coronary calcification in blood vessels does not rule out the potential existence of stenosis, and should not be used to decide if revascularization is needed, according to a study in the Feb. 16 issue of the Journal of the American College of Cardiology.

Ilan Gottlieb, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a substudy in 291 patients from the Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors study. In their substudy, the researchers assessed whether the absence of coronary calcium (calcium score of zero) as determined by low radiation coronary calcium scans excludes the existence of at least 50 percent coronary stenosis and the necessity for intervention, as suggested in the latest American Heart Association guidelines.

The researchers found that of 72 patients in the study group who had a calcium score of zero, 14 (19 percent) had at least one stenosis of 50 percent or greater. In revascularization procedures on nine patients with a calcium score of zero in a total of 383 vessels, 47 vessels (12 percent) were found to have at least 50 percent stenosis. In 64 totally blocked vessels, 13 vessels (20 percent) exhibited no calcification.

"The absence of coronary calcification does not exclude obstructive stenosis or the need for revascularization among patients with high enough suspicion of coronary artery disease to be referred for coronary angiography, in contrast with the published recommendations. Total coronary occlusion frequently occurs in the absence of any detectable calcification," the authors conclude.

The study was supported in part by a grant from Toshiba Medical Systems; several study authors reported financial relationships with Toshiba and other medical device and pharmaceutical companies.

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