Obstructive coronary artery disease with a coronary artery calcium score of 0: A case report

Abstract

Coronary artery calcium (CAC) scoring has emerged as a useful tool in identifying patients who may benefit from more aggressive risk factor modification and for prognostication. Although a CAC score of 0 is associated with a very low prevalence of obstructive epicardial coronary artery disease and low event rates, it can also provide a false sense of reassurance. We present a case of a 39‐year‐old woman with a CAC score of 0 obtained as part of a coronary computerized tomography angiography study that was ultimately found to have significant left anterior descending artery disease requiring percutaneous coronary intervention and a stent.

Association of silent myocardial infarction on electrocardiogram and coronary artery calcium: The Multi‐Ethnic Study of Atherosclerosis

“…This observation is best explained by those with SMI on ECG being a heterogenous group, with some having no significant coronary artery disease. These participants may have SMI due to the fact that there are multiple mechanisms of myocardial infarction, including several that do not include atherosclerosis in the causal pathway, such as non‐ischemic cardiomyopathies, acute myocardial infarctions without non‐obstructive coronary artery disease (Lindahl et al, 2017 ), and obstructive coronary artery disease that is secondary to lipid‐rich plaque, without associated coronary artery calcification (German et al, 2020 ). Thus, even though patients with SMI on ECG have an increased odds of elevated CAC, there is likely value in formal CAC scanning, rather than considering all patients with SMI to have presumptively high CAC scores.…”