https://doi.org/10.1007/s00392-025-02625-4
1Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland; 2CCB am AGAPLESION BETHANIEN KRANKENHAUS Medizinisches Versorgungszentrum Frankfurt am Main, Deutschland
Background and Aims:
Coronary computed tomography angiography (CCTA) provides for detailed visualization of coronary anatomy, enabling the diagnosis of coronary artery disease (CAD). CCTA can detect high-grade stenoses, but also non-obstructive plaques, thus generating crucial information for accurate prognostication and informed treatment planning. Although established risk scores and percentile distributions exist for calcified plaque components across various age and gender groups, e.g., the Agatston score, much less data is available regarding the overall prevalence of coronary plaques in a representative patient population undergoing CCTA, particularly regarding the distribution of non-calcified plaque components. This study aims to analyze coronary plaque characteristics in a German outpatient cohort to better understand plaque distribution and composition and to establish reference plaque scores and percentiles specifically for non-calcified plaque components.
Coronary computed tomography angiography (CCTA) provides for detailed visualization of coronary anatomy, enabling the diagnosis of coronary artery disease (CAD). CCTA can detect high-grade stenoses, but also non-obstructive plaques, thus generating crucial information for accurate prognostication and informed treatment planning. Although established risk scores and percentile distributions exist for calcified plaque components across various age and gender groups, e.g., the Agatston score, much less data is available regarding the overall prevalence of coronary plaques in a representative patient population undergoing CCTA, particularly regarding the distribution of non-calcified plaque components. This study aims to analyze coronary plaque characteristics in a German outpatient cohort to better understand plaque distribution and composition and to establish reference plaque scores and percentiles specifically for non-calcified plaque components.
Methods:
This analysis included all patients who underwent CCTA using a third-generation dual-source scanner between July 2017 and June 2020 for suspected coronary artery disease. Quantitative assessment and characterization of atherosclerotic plaques were performed on all coronary arteries collectively and on each vessel individually, measuring plaque volume, and plaque burden, with differentiation among total, calcified, non-calcified, and low-attenuation plaque components.
This analysis included all patients who underwent CCTA using a third-generation dual-source scanner between July 2017 and June 2020 for suspected coronary artery disease. Quantitative assessment and characterization of atherosclerotic plaques were performed on all coronary arteries collectively and on each vessel individually, measuring plaque volume, and plaque burden, with differentiation among total, calcified, non-calcified, and low-attenuation plaque components.
Results:
The analysis included 5,412 patients (60.8% male) with a mean age of 63 ± 11.5 years. Among these, 1,783 patients (32.9%) showed no evidence of CCTA-defined coronary atherosclerosis, while 3,629 patients (67.1%) exhibited coronary plaques. Obstructive CAD was identified in 1,584 patients (29.3%) of the total study population. Notably, in 99 patients (1.8%), exclusively non-calcified plaque was determined and no calcified components. Among patients with coronary atherosclerosis, the greatest mean plaque burden was found in the left anterior descending coronary artery (69.6%), followed by the right coronary artery (18.7%) and the left circumflex artery (11.6%).
The analysis included 5,412 patients (60.8% male) with a mean age of 63 ± 11.5 years. Among these, 1,783 patients (32.9%) showed no evidence of CCTA-defined coronary atherosclerosis, while 3,629 patients (67.1%) exhibited coronary plaques. Obstructive CAD was identified in 1,584 patients (29.3%) of the total study population. Notably, in 99 patients (1.8%), exclusively non-calcified plaque was determined and no calcified components. Among patients with coronary atherosclerosis, the greatest mean plaque burden was found in the left anterior descending coronary artery (69.6%), followed by the right coronary artery (18.7%) and the left circumflex artery (11.6%).
In the total population, the 50th, 70th, and 90th percentile values for total coronary plaque burden were 28.8 mm³, 102.2 mm³, and 302.0 mm³, respectively. For non-calcified plaque components, these values were 3.8 mm³, 26.5 mm³, and 102.4 mm³; and for low-attenuation plaques, they were 0 mm³, 0.4 mm³, and 5.1 mm³.
Conclusions:
This study provides the first comprehensive data on coronary plaque burden and composition in a large German outpatient cohort undergoing CCTA, illustrating the prevalence and distribution of both calcified and non-calcified plaque components. The findings underscore the value of CCTA in detecting non-stenosing plaques, which are vital for early CAD diagnosis and risk assessment. By establishing reference values and percentiles for total, non-calcified, and low-attenuation plaque burdens, this study significantly advances our understanding of coronary plaque distribution in the general population.
This study provides the first comprehensive data on coronary plaque burden and composition in a large German outpatient cohort undergoing CCTA, illustrating the prevalence and distribution of both calcified and non-calcified plaque components. The findings underscore the value of CCTA in detecting non-stenosing plaques, which are vital for early CAD diagnosis and risk assessment. By establishing reference values and percentiles for total, non-calcified, and low-attenuation plaque burdens, this study significantly advances our understanding of coronary plaque distribution in the general population.
Total coronary plaque volume:
|
Percentiles |
20th |
40th |
50th |
70th |
90th |
|
Plaque volume in mm³ |
0 |
10.5 |
28.8 |
102.2 |
302.0 |
Non-calcified coronary plaque volume:
|
Percentiles |
20th |
40th |
50th |
70th |
90th |
|
Plaque volume in mm³ |
0 |
0.4 |
3.8 |
26.5 |
102.4 |
Low-attenuation coronary plaque volume:
|
Percentiles |
20th |
40th |
50th |
70th |
90th |
|
Plaque volume in mm³ |
0 |
0 |
0 |
0.4 |
5.1 |