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