Coronary Artery Disease – Noncalcified Plaque

History: 55 year old male with a history of diabetes, hypertension and hyperlipidemia with atypical chest pain. 

Single axial coronary artery CT scan shows marked stenosis of the left anterior descending coronary artery at the proximal portion near the bifurcation of the left main coronary artery.

On additional images, this patient had a paucity of calcified plaque (his Agatston score placed him at a very low risk for a major cardiac episode) and the majority of his coronary artery disease consisted of noncalcified atherosclerotic plaque. This is a potential pitfall of using solely calcium scoring to predict major cardiac episode risk. Some have suggested noncalcified plaque places patients at a higher risk for cardiac events. This patient should undergo urgent evaluation by a cardiologist, and possibly will need percutaneous coronary intervention (PCI).

Most coronary artery disease is atherosclerotic in nature; however, alternative diagnoses include Lupus, Bechet disease, Kawasaki disease, and Marfan syndrome.