Phenotyping coronary plaque by computed tomography in premature coronary artery disease
Author:
Rahoual Ghilas1, Zeitouni Michel1, Charpentier Etienne2ORCID, Ritvo Paul-Gydeon2, Rouanet Stéphanie3, Procopi Niki1ORCID, Boukhelifa Sena1, Charleux Pierre1, Guedeney Paul1, Kerneis Mathieu1ORCID, Barthélémy Olivier1, Silvain Johanne1, Montalescot Gilles1, Redheuil Alban2, Collet Jean-Philippe1ORCID
Affiliation:
1. ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université , 47-83 boulevard de l'Hôpital, Paris 75013 , France 2. INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d’Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université , Paris 75013 , France 3. Statistician Unit, StatEthic, ACTION Study Group , Levallois-Perret , France
Abstract
Abstract
Aims
Premature coronary artery disease (CAD) is an aggressive disease with multiple recurrences mostly related to new coronary lesions. This study aimed to compare coronary plaque characteristics of individuals with premature CAD with those of incidental plaques found in matched individuals free of overt cardiovascular disease, using coronary computed tomography angiography (CCTA).
Methods and results
Of 1552 consecutive individuals who underwent CCTA, 106 individuals with history of acute or stable obstructive CAD ≤45 years were matched by age, sex, smoking status, cardiovascular heredity, and dyslipidaemia with 106 controls. CCTA were analysed for Coronary Artery Disease Reporting and Data System score, plaque composition, and high-risk plaque (HRP) features, including spotty calcification, positive remodelling, low attenuation, and napkin-ring sign. The characteristics of 348 premature CAD plaques were compared with those of 167 incidental coronary plaques of matched controls. The prevalence of non-calcified plaques was higher among individuals with premature CAD (65.1 vs. 30.2%, P < 0.001), as well as spotty calcification (42.5 vs. 17.9%, P < 0.001), positive remodelling (41.5 vs. 9.4%, P < 0.001), low attenuation (24.5 vs. 3.8%, P < 0.001), and napkin-ring sign (1.9 vs. 0.0%). They exhibited an average of 2.2 (2.7) HRP, while the control group displayed 0.4 (0.8) HRP (P < 0.001). Within a median follow-up of 24 (16, 34) months, individuals with premature CAD and ischaemic recurrence (n = 24) had more HRP [4.3 (3.9)] than those without ischaemic recurrence [1.5 (1.9)], mostly non-calcified with low attenuation and positive remodelling.
Conclusion
Coronary atherosclerosis in individuals with premature CAD is characterized by a high and predominant burden of non-calcified plaque and unusual high prevalence of HRP, contributing to disease progression with multiple recurrences. A comprehensive qualitative CCTA assessment of plaque characteristics may further risk stratify our patients, beyond cardiovascular risk factors.
Funder
Action Study Group
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine
Cited by
1 articles.
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1. Lipid Lowering After Myocardial Infarction;Journal of the American College of Cardiology;2023-10
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