Usefulness of Coronary Computed Tomography Angiography Evaluating the Clinical Importance of Coronary Artery Calcium and Noncalcified Plaque in Asymptomatic Patients

Direct noninvasive assessment of the characteristics of coronary atherosclerotic plaques is important to improve cardiovascular risk stratification and to monitor the course of coronary artery disease. Coronary computed tomography angiography (CCTA) has become an effective tool for noninvasive evaluation of coronary artery calcium and plaque components. Using CCTA, atherosclerotic plaques can be divided into calcified and non-calcified sub-types based on density measurements. Noncalcified plaques (NCP) consist of fibrotic, fibro-fatty and necrotic subtypes. Accurate detection and quantification of atherosclerotic plaques-both calcified and noncalcified-are needed to improve risk stratification and monitor the progression or regression of the disease. Compared to calcified plaques (CP), NCPs are associated with increased risk of acute coronary syndromes. The prevalence of NCP identified by CCTA is not relatively low in asymptomatic patients without coronary artery calcium. However, clinical risk factors and prognostic significance of NCP in asymptomatic patients without coronary artery calcium are not well known. Editorial