This new article by Hausleiter J et al in a recent JACC issue, looks at the prevalence of calcified and non-calcified plaques in 161 consecutive patients with intermediate risk.
Interestingly 98 patients had a positive calcium score and would have been been diagnosed to have disease. Thirty-eight of these also had noncalcified plaques. Of the other 63 patients, 10 had non-calcified plaques, which means that of these 161 patients, 10 patients (6.2%) with some form of coronary artery disease (CAD) would not have been picked up by just calcium scoring.
Their conclusion is "With the use of 64-slice CT, clearly discernible noncalcified atherosclerotic coronary plaques can be detected in a large group of patients with an intermediate risk for having CAD. The assessment of these plaques by CT angiography may allow for improved cardiovascular risk stratification."
The editorial comment by Micheal Budoff however is even more interesting, because it puts the whole issue of the need to detect soft plaques in perspective, along with calcium scoring data - I will discuss this next week.
This patient has a mixed plaque, predominantly soft tissue with some calcification. There is positive remodelling with possible ulceration.