Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis

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#adult #aged #female #humans #male

Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis

Sama et al., 2024 | J Cardiovasc Comput Tomogr | Meta Analysis

Citation

Sama Carlson, Abdelhaleem Ahmed, ... Hamirani Yasmin S. Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis. J Cardiovasc Comput Tomogr. 2024;18(1):43-49. doi:10.1016/j.jcct.2023.10.002

Abstract

BACKGROUND: There is growing interest in understanding the coronary atherosclerotic burden in asymptomatic patients with zero coronary artery calcium score (CACS). In this population, we aimed to investigate the prevalence and severity of non-calcified coronary plaques (NCP) as detected by coronary CT angiography (CCTA), and to analyze the associated clinical predictors. METHODS: This was a systematic review with meta-analysis of studies indexed in PubMed/Medline and Web of Science from inception of the database to March 31st, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I2 statistics whilst Funnel plots and Egger's test were used to assess for publication bias. RESULTS: From a total of 14 studies comprising 37808 patients, we approximated the pooled summary estimates for the overall prevalence of NCP to be 10% (95%CI: 6%-13%). Similarly, the pooled prevalence of obstructive NCP was estimated at 1.1% (95%CI: 0.7%-1.5%) from a total of 10 studies involving 21531 patients. Hypertension [OR: 1.46 (95%CI:1.31-1.62)] and diabetes mellitus [OR: 1.69 (95%CI: 1.41-1.97)] were significantly associated with developing any NCP, with male gender being the strongest predictor [OR: 3.22 (95%CI: 2.17-4.27)]. CONCLUSION: There is a low burden of NCP among asymptomatic subjects with zero CACS. In a subset of this population who have clinical predictors of NCP, the addition of CCTA has a potential to provide a better insight about occult coronary atherosclerosis, however, a risk-benefit approach must be factored in prior to CCTA use given the low prevalence of NCP.

Key Findings

From a total of 14 studies comprising 37808 patients, we approximated the pooled summary estimates for the overall prevalence of NCP to be 10% (95%CI: 6%-13%). Similarly, the pooled prevalence of obstructive NCP was estimated at 1.1% (95%CI: 0.7%-1.5%) from a total of 10 studies involving 21531 patients. Hypertension [OR: 1.46 (95%CI:1.31-1.62)] and diabetes mellitus [OR: 1.69 (95%CI: 1.41-1.97)] were significantly associated with developing any NCP, with male gender being the strongest predicto

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population zero coronary artery calcium
Sample Size 37808
Age Range See abstract
Condition hypertension

MeSH Terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Asymptomatic Diseases
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Vessels
  • Plaque, Atherosclerotic
  • Predictive Value of Tests
  • Prevalence
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Vascular Calcification

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Meta-Analysis, Systematic Review, Journal Article
  • Vertical: calcium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09