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Objective: We sought to identify the predictors of non-calcified plaque (NCP) burden in patients with low coronary artery calcium (CAC) scores of 1e100. Methods: We studied 920 consecutive patients clinically referred for coronary CT angiography (CCTA) with concomitant CAC scoring. The 276 patients with CAC 1e100 were divided into four groups based on the CAC score: CAC ¼ 0, 1e10, 11e50, and 51e100. Univariate and multivariate linear regression analyses were performed for the demographic, risk factor, and CAC score predictors of number of coronary segments with NCP. Results: Mean age was 55 � 11 years and 56% were women. Demographics and risk factors failed to identify NCP involvement in univariate models. The lone predictor of NCP burden was the absolute CAC score, which was persistently associated with NCP in multivariable models (CAC 51e100 vs. CAC 1e10, bcoefficient 0.35, p ¼ 0.03). Conclusions: Absolute CAC score is the lone robust predictor of NCP burden when CAC is 1e100. Risk within this mild coronary calcification group is likely heterogeneous, driven by the absolute CAC score. 2013 Elsevier Ireland Ltd. All rights reserved.

Background— Secondary prevention therapies improve longitudinal outcomes in patients with coronary artery disease. Previous studies showed that teaching hospitals (THs) more consistently use evidence-based secondary prevention therapies than non-THs (NTHs). It is unclear whether these differences persist after initiation of a national quality improvement system. Methods and Results— We analyzed 270902 patients across 361 hospitals in the Get With The Guidelines–Coronary Artery Disease program from June 2000 to September 2009. The primary outcome was guideline-concordant care, defined as compliance with all Get With The Guidelines–Coronary Artery Disease quality measures: (1) aspirin within 24 hours, (2) aspirin at discharge, (3) angiotensin-converting enzyme inhibitor/angiotensin receptor blockers for systolic dysfunction, (4) β-blockers at discharge, (5) lipid therapy if low-density lipoprotein >100 mg/dL, and (6) smoking cessation. We used multivariate modeling to compare the relationship between TH and NTH status on quality measures, in-hospital mortality, and length of stay. Guideline-concordant care was higher at THs (78.4% versus 73.3%; PP =0.01). Guideline-concordant care increased from 2000 to 2009 at THs (n=176; 65.3%→88.3%; adjusted odds ratio for year increase, 1.24 [confidence interval, 1.16–1.30; PP 4 days; confidence interval, 0.58–0.94) from 2000 to 2009. Lower in-hospital mortality was observed at THs (3.7% versus 4.4% at NTHs; P Conclusions— Adherence to guideline-recommended therapies increased over time with participation in the Get With The Guidelines–Coronary Artery Disease program, regardless of the teaching status. Guideline-concordant care over the full decade was higher in THs; however, NTHs demonstrated greater incremental improvement over time.