Understanding Your Coronary CT Results: A Patient's Guide

Receiving your coronary CT angiogram results can feel overwhelming, especially when the report is filled with medical terms like stenosis, plaque burden, and luminal narrowing. Understanding what each finding means helps you have a more productive conversation with your cardiologist and make informed decisions about your heart health.

This guide walks you through the key sections of a typical coronary CT angiography report, explains what the numbers and terms mean, and outlines what to expect after your results are reviewed.

What Does a Coronary CT Angiogram Report Include?

A coronary CT angiogram report is a structured document prepared by a radiologist or cardiac imaging specialist. It describes the condition of your coronary arteries, including whether any narrowing (stenosis) or plaque buildup is present. The report typically covers the left main artery, left anterior descending (LAD) artery, left circumflex artery, and right coronary artery, along with their branches.

Most reports also include a calcium score, which quantifies the amount of calcified plaque in the coronary arteries. Together, these findings give your doctor a detailed picture of your coronary artery health.

Understanding Stenosis Percentage

Stenosis refers to the narrowing of an artery caused by plaque buildup on the vessel walls. In your report, stenosis is expressed as a percentage, representing how much the artery lumen (the open channel through which blood flows) has been reduced. A 0% stenosis means the artery is completely open, while 100% means it is fully blocked.

It is important to understand that stenosis percentages on CT angiography are estimated visually by the reporting physician. They are not absolute measurements and may differ slightly from findings on invasive coronary angiography. However, CT angiography provides highly reliable assessment in most cases.

Mild Stenosis: What Does Less Than 50% Mean?

Mild stenosis, typically described as less than 50% narrowing, means plaque is present in one or more coronary arteries but is not yet blocking blood flow significantly. Most patients with mild stenosis do not experience symptoms such as chest pain or shortness of breath during daily activities.

However, the presence of any plaque is clinically important. It confirms that coronary artery disease has started, even if it is in its early stages. Your cardiologist may recommend lifestyle changes, cholesterol-lowering medications (statins), blood pressure management, and regular follow-up imaging to monitor progression.

Early detection at this stage is one of the greatest advantages of coronary artery disease screening. Addressing risk factors now can slow or even stabilize plaque progression.

One of our patients, a 55-year-old businessman, came to DCDC feeling anxious after receiving his CT angiogram report showing "50% stenosis in the LAD." He assumed this meant half his artery was blocked and that surgery was imminent. After sitting down with him and walking through the report in detail, we explained that 50% stenosis is classified as moderate and does not automatically require a procedure. Instead, we initiated statin therapy, optimized his blood pressure, and scheduled a follow-up stress test to assess functional significance. Six months later, his risk factors were well controlled and he felt reassured knowing exactly where he stood and what the plan was.

"The numbers on a CT angiogram report can be frightening when taken out of context," says Dr. Shahoo Mazhari, Consultant Cardiologist at DCDC. "A 50% stenosis does not mean you are halfway to a heart attack. It means we have caught the disease at a stage where we can make a real difference with medication and lifestyle changes."

Moderate Stenosis: The 50-69% Range

Moderate stenosis means the artery has a noticeable narrowing that may begin to limit blood flow, particularly during physical exertion. Patients with moderate stenosis may experience chest discomfort during exercise, climbing stairs, or periods of stress, though some remain asymptomatic.

When moderate stenosis is identified on a CT angiogram, your cardiologist may recommend a functional test such as a stress echocardiogram or myocardial perfusion scan to determine whether the narrowing is actually limiting blood supply to the heart muscle. Treatment decisions at this stage depend on whether the stenosis is causing ischemia (reduced blood flow).

Severe Stenosis: 70% or Greater

Severe stenosis of 70% or more indicates significant narrowing that is very likely to reduce blood flow to the heart muscle. This level of blockage often requires further evaluation through invasive coronary angiography (catheter-based), which allows the cardiologist to directly visualize the arteries and potentially treat the blockage during the same procedure.

Treatment for severe stenosis may include coronary stenting (percutaneous coronary intervention) or, in cases involving multiple severe blockages or the left main artery, coronary artery bypass grafting (CABG). Medical therapy with medications remains an important part of treatment regardless of whether a procedure is performed.

Soft Plaque vs Hard Plaque: Why Plaque Type Matters

One of the unique advantages of coronary CT angiography over traditional stress tests is its ability to characterize plaque composition. Your report may describe plaque as calcified (hard), non-calcified (soft), or mixed. Understanding the difference is important because plaque type influences risk.

Calcified (Hard) Plaque

Calcified plaque appears bright white on CT images and represents older, more stable deposits of calcium within the artery wall. While calcified plaque contributes to overall plaque burden, it is generally considered more stable and less likely to rupture suddenly. The calcium score on your report specifically measures this type of plaque.

Non-Calcified (Soft) Plaque

Non-calcified or soft plaque appears darker on CT images and contains lipid (fatty) material, fibrous tissue, or a combination. Soft plaque is considered higher risk because it is more prone to rupture. When soft plaque ruptures, it can trigger a blood clot that suddenly blocks the artery, leading to a heart attack. This is why cardiologists pay close attention to soft plaque findings even when the stenosis percentage is relatively low.

Mixed Plaque

Mixed plaque contains both calcified and non-calcified components. Most coronary plaques fall into this category as they progress over time. The proportion of soft to hard components helps your cardiologist assess overall risk.

"What I tell my patients is that plaque type can be just as important as stenosis percentage," says Dr. Shahoo Mazhari, Consultant Cardiologist at DCDC. "A patient with 30% stenosis from soft plaque may actually need more aggressive treatment than someone with 50% stenosis from stable, calcified plaque. That is the kind of nuance CT angiography gives us."

Other Important Terms in Your Report

• Plaque burden: Refers to the total amount of plaque across all coronary arteries. A high plaque burden increases cardiovascular risk even if no single artery has severe stenosis.
• Positive remodeling: The artery wall expands outward to accommodate plaque, maintaining blood flow. While it keeps the lumen open, positive remodeling is associated with higher-risk (vulnerable) plaque.
• Luminal narrowing: Another term for stenosis; it describes how much the open channel of the artery has been reduced.
• Anomalous coronary artery: A congenital variation in the origin or path of a coronary artery, which is sometimes identified incidentally on CT.
• Non-diagnostic segment: A portion of the artery that could not be clearly evaluated, often due to motion artifact or heavy calcification.

How Calcium Score Relates to CT Angiography Findings

The calcium score is often calculated alongside the CT angiogram. It measures the total amount of calcified plaque in all coronary arteries and is expressed as an Agatston score. A score of 0 suggests no calcified plaque, while scores above 400 indicate extensive calcification.

However, it is important to understand that the calcium score only reflects calcified plaque. A patient can have a calcium score of 0 yet have non-calcified (soft) plaque visible on the CT angiogram. This is one reason why CT angiography is considered more comprehensive than a calcium score alone for evaluating coronary artery disease.

What Happens After You Receive Your Results

After your coronary CT angiogram results are finalized, your cardiologist will review the findings in the context of your symptoms, risk factors, and medical history. The following steps depend on the severity of findings:

• Normal or minimal findings: Reassurance, lifestyle optimization, and risk factor management. Follow-up imaging may be scheduled in 3-5 years.
• Mild to moderate stenosis: Medication adjustment (statins, aspirin, blood pressure control), dietary changes, exercise guidance, and closer monitoring.
• Severe stenosis: Referral for invasive coronary angiography and possible intervention (stenting or surgery).
• Significant soft plaque: Aggressive medical therapy even if stenosis is not yet severe, due to higher rupture risk.

It is also common for your cardiologist to order additional tests such as a stress echocardiogram, blood tests for lipid levels, or a repeat scan after a treatment period to assess whether plaque has stabilized.

Questions to Ask Your Cardiologist About Your CT Results

• What is the most significant finding on my CT angiogram?
• Is the plaque mostly calcified, soft, or mixed?
• Do I need any additional tests based on these results?
• Should I start or change any medications?
• How often should I repeat imaging to monitor changes?
• What lifestyle changes will have the greatest impact on slowing progression?

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Final Thoughts

Your coronary CT angiogram report provides a detailed snapshot of your heart's artery health. Understanding terms like stenosis percentage, plaque type, and calcium score empowers you to participate actively in your care. Mild or moderate findings do not necessarily mean immediate intervention, but they do signal that attention and prevention are needed.

The most important step after receiving your results is having a thorough discussion with your cardiologist. Together, you can develop a plan that addresses your specific findings, whether that involves medication, lifestyle changes, further testing, or a combination of approaches. Early action based on CT angiogram findings can significantly reduce long-term cardiovascular risk. If follow-up imaging is recommended, learn about CT angiogram pricing in Dubai.

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Dr. Shahoo Mazhari

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Consultant Cardiologist

MD, Board Certified in Cardiology

Dr. Shahoo Mazhari is a Consultant Cardiologist specializing in non-invasive cardiac imaging, coronary CT angiography, and preventive cardiology at DCDC Dubai Healthcare City.

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