A high-risk, high-grade proximal left anterior descending coronary artery stenosis in a patient with a zero calcium score

Abstract

A 58-year-old man with intermediate risk for obstructive coronary artery disease presents with atypical CP. A cardiac computedtomographic angiogram with calcium scoring was obtained. Despite a zero calcium score he was found to have a high risk, critical,proximal left anterior descending artery (LAD) stenosis. During the post-scan monitoring period, he developed unstable anginasymptoms. He was admitted and ruled out for infarction. Invasive coronary angiography confirmed his severe LAD stenosis and adrug eluting stent was placed in the proximal LAD. This case nicely illustrates the cardiac computed tomographic angiographycharacteristics of a high risk coronary stenosis. In addition, it emphasizes that while a zero calcium score is associated with agood prognosis, it is not tantamount to the absence of coronary artery disease and good clinical judgment must be employedwhen caring for symptomatic patients, despite a zero calcium score.