Abstract
(1) Background: Whether coronary computed tomography angiography (CTA) or the coronary artery calcium score (CACS) should be used for diagnosis of coronary heart disease, is an open debate. The aim of our study was to compare the atherosclerotic profile by coronary CTA in a young symptomatic high-risk population (age, 19–49 years) in comparison with the coronary artery calcium score (CACS). (2) Methods: 1137 symptomatic high-risk patients between 19–49 years (mean age, 42.4 y) who underwent coronary CTA and CACS were stratified into six age groups. CTA-analysis included stenosis severity and high-risk-plaque criteria (3) Results: Atherosclerosis was more often detected based on CTA than based on CACS (45 vs. 27%; p < 0.001), 50% stenosis in 13.6% and high-risk plaque in 17.7%. Prevalence of atherosclerosis was low and not different between CACS and CTA in the youngest age groups (19–30 y: 5.2 and 6.4% and 30–35 y: 10.6 and 16%). In patients older than >35 years, the rate of atherosclerosis based on CTA increased (p = 0.004, OR: 2.8, 95%CI:1.45–5.89); and was higher by CTA as compared to CACS (34.9 vs. 16.7%; p < 0.001), with a superior performance of CTA. In patients older than 35 years, stenosis severity (p = 0.002) and >50% stenosis increased from 2.6 to 12.5% (p < 0.001). High-risk plaque prevalence increased from 6.4 to 26.5%. The distribution of high-risk plaque between CACS 0 and >0.1 AU was similar among all age groups, with an increasing proportion in CACS > 0.1 AU with age. A total of 24.9% of CACS 0 patients had coronary artery disease based on CTA, 4.4% > 50% stenosis and 11.5% had high-risk plaque. (4) Conclusions: In a symptomatic young high-risk population older than 35 years, CTA performed superior than CACS. In patients aged 19–35 years, the rate of atherosclerosis was similar and low based on both modalities. CACS 0 did not rule out coronary artery disease in a young high-risk population.
Highlights
The coronary artery calcium score (CACS) is a screening tool for coronary artery disease (CAD) in asymptomatic low-to-intermediate risk patients, based on trials mainly enrolling adults older than 50 years [1,2,3]. 4.0/).Coronary artery calcium has been associated with a 3-up to 5-fold increased risk of fatal and nonfatal coronary heart disease events in younger individuals between 32 and 46 years of age [1], and CACS of >100 Agatston Units (AU) with early death [1]
Recent data showed that coronary heart disease mortality rate is low for younger patients aged 30–49 years with CACS 0 [2]
The rate of atherosclerosis based on computed tomography angiography (CTA) was significantly higher as compared to CACS (45% vs. 27%; p < 0.001)
Summary
The coronary artery calcium score (CACS) is a screening tool for coronary artery disease (CAD) in asymptomatic low-to-intermediate risk patients, based on trials mainly enrolling adults older than 50 years [1,2,3]. Coronary artery calcium has been associated with a 3-up to 5-fold increased risk of fatal and nonfatal coronary heart disease events in younger individuals between 32 and 46 years of age [1], and CACS of >100 Agatston Units (AU) with early death [1]. Recent data showed that coronary heart disease mortality rate is low for younger patients aged 30–49 years with CACS 0 [2]. Mortality is naturally lower in this age group, while non-fatal STEMI or NSTEMI–ACS occurs more often, which were not included as study endpoints in most of those trials [2,4]. Coronary CTA may be a superior imaging modality in this population, due to its ability to detect high-risk plaque and graduate stenosis severity [11]
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