A Retrospective CTCA Study of Premature Coronary Artery Disease (CAD) in Patients Presenting with Chest Pain

Abstract

Background: Risk of myocardial infarction (MI) is related to coronary atherosclerosis which in males before 55 years or in females before 65 years is premature coronary artery disease (CAD), this being accelerated by modifiable risk factors (Framingham Study). This study aimed at quantifying males aged ≤ 55 and females ≤ 65 who had CT coronary angiography (CTCA) evidence of CAD and their risk profile. Methods: Of 333 patients with chest pain 87 had CTCA between 2012–2016. 21 were excluded for not meeting age criteria. A retrospective chart audit of 66 patients was undertaken. Results: 11 of 29 males and 13 of 37 females had significant CAD. The median age was 54 for females, 47 for males, with 35% of females and 39% of males having CTCA evidence of CAD. 4 had troponin positive chest pain with atherosclerosis. Males with premature CAD were likely to be dyslipidaemic (64%) and smokers (64%) while females were more likely to be hypertensive (62%). 36% males and 46% females had family history. Calcium scores varied between 0- 200 in minor disease and 0 - 677 in moderate–severe disease. Males had higher calcium scores (0-677) than females (0-290). Conclusion: This study has identified a continuum of progressive CAD which may be picked up on CTCA. Together with risk factors, CTCA identifies a cohort of patients amenable to early treatment to prevent progression.