Prevalence of soft plaque detection with computed tomography.

oronary calcium assessment is being increasingly used in linical practice for risk stratification. Higher coronary alcium scores are associated with increased plaque burden nd increased cardiovascular risk. One concern is the presnce of isolated lipid-laden (soft) plaque in the setting of a egative study (zero calcium score). In this issue of the ournal, Hausleiter et al. (1) suggest that the ability to detect ipid-laden coronary plaques with cardiac computed tomogaphy (CT) angiography would possibly improve risk stratfication of these patients. The authors studied 161 consective patients with an intermediate risk for having coronary rtery disease (CAD) and CT datasets were evaluated for he presence of coronary calcifications, noncalcified plaques, nd/or lumen narrowings. Coronary calcifications were bsent in 63 of 161 (39%) patients, and the overall prevaence of patients with noncalcified plaques as the only anifestation of CAD was 6.2% (10 of 161 patients). The uthors surmise that with CT, “discernible noncalcified therosclerotic coronary plaques can be detected in a large roup of patients with an intermediate risk for having CAD. he assessment of these plaques by CT angiography may llow for improved cardiovascular risk stratification.” The asic premise of the paper is that the detection of isolated oft plaque adds significant information for the clinician. hus, the question becomes: does noncalcific plaque detecion improve on coronary calcium assessment?