Coronary artery anomalies in patients with zero calcium score: A new evidence supports the 2016-NICE guidance

• Published in: European journal of radiology Open 2020-01, Vol.7, p.100211-100211, Article 100211
• Main Authors: Abdalla, Khalid M., Aleshawi, Abdelwahab J., Hinawi, Yousef, Bani Hani, Dia, Ababneh, Alaeldin A.
• Format: Article
• Language: English
• Subjects: Angelini's classification; Arrhythmias; Coronary computed tomography angiography; Stable angina
• ISSN: 2352-0477; 2352-0477
• DOI: 10.1016/j.ejro.2019.12.005

•High prevalence of coronary artery anomaly in young with zero calcium score.•It is preferable to perform CCTA in young with symptoms even if the CAC is zero.•This is important especially in Asian and Middle Eastern countries.•These data support the implantation of the new NICE guidelines. Currently, guidelines from around the world endorse measurement of coronary artery calcium (CAC) to improve clinical risk prediction in appropriately selected asymptomatic and stable symptomatic individuals. A CAC score of zero may discourage from further testing as coronary computed tomography angiography (CCTA). We investigate the presence of malignant coronary artery anomalies (CAA)s among stable symptomatic patients with zero CAC. A total of 281 individuals' information was obtained. These individuals had low to intermediate pre-test probability of coronary artery disease, complained of stable typical or atypical chest pain, were not known to have CAD, and had CAC scan score of zero. After investigating the CCTA, Angelini's classification system for CAA was utilized in adapted form to determine the presence, the class and type of the CAA. The CAAs were detected in 16 (5.7 %) patients on CCTA, 15 (8.1 %) of them were below 45 years. The mean age for patients with CAAs was 31.8. According to Angelini classification system, most of the detected CAAs were malignant such as the origination of the coronary artery from the opposite sinus with arterial course between the aortic and pulmonary trunks and the intramural muscular bridge course. It is preferable to perform CCTA in young patients with cardiac symptoms, especially in Asian and Middle Eastern countries even of the CAC score is zero.