Osborne-Grinter M, Kwiecinski J, Doris M, et al. - A good but not perfect prognosis was observed in relation to zero coronary artery calcium score (CACS) in patients with stable chest pain, and CACS failed to rule out obstructive coronary artery disease, non-obstructive plaque, or adverse plaque phenotypes, including low-attenuation plaque.

• In this post-hoc analysis of SCOT-HEART trial participants, computed tomography images and 5-year clinical results were analyzed.

• Overall 1,769 patients were included; 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high, and 8% very high CACS.

• In the zero CACS group, non-obstructive disease and obstructive disease were evident in 14% and 2%, respectively, and 2% had visually assessed adverse plaques, 13% had low-attenuation plaque burden >4%.

• Elevated non-calcified and low-attenuation plaque burden was observed between patients with zero, minimal, and low CACS, but no statistically significant difference was evident between those exhibiting medium, high, and very high CACS.

• 41 patients suffered myocardial infarction, of which, 10% had zero CACS.

• Myocardial infarction was only predicted by CACS >1,000 Agatston units and low-attenuation plaque burden, independent of obstructive disease, and 10-year cardiovascular risk score.