Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467, USA.
Department of Cardiology, CEDIMAT, Arturo Logroño, Plaza de la Salud, Dr. Juan Manuel Taveras Rodríguez, C. Pepillo Salcedo esq, Santo Domingo, Dominican Republic.
Eur Heart J Cardiovasc Imaging. 2024 Jul 31;25(8):1071-1082. doi: 10.1093/ehjci/jeae094.
The atherosclerotic profile and advanced plaque subtype burden in symptomatic patients ≤45 years old have not been established. This study aimed to assess the prevalence and predictors of coronary artery calcium (CAC), plaque subtypes, and plaque burden by coronary computed tomography angiography (CCTA) in symptomatic young patients.
We included 907 symptomatic young patients (18-45 years) from Montefiore undergoing CCTA for chest pain evaluation. Prevalence and predictors of CAC, plaque subtypes, and burden were evaluated using semi-automated software. In the overall population (55% female and 44% Hispanic), 89% had CAC = 0. The likelihood of CAC or any plaque by CCTA increased with >3 risk factors {RFs, odds ratio [OR] 7.13 (2.14-23.7) and OR 10.26 (3.36-31.2), respectively}. Any plaque by CCTA was present in 137 (15%); the strongest independent predictors were age ≥35 years [OR 3.62 (2.05-6.41)] and family history of premature coronary artery disease (FHx) [OR 2.76 (1.67-4.58)]. Stenosis ≥50% was rare (1.8%), with 31% of those having CAC = 0. Significant non-calcified plaque (NCP, 37.2%) and low-attenuation plaque (LAP, 4.24%) burdens were seen, even in those with non-obstructive stenosis. Among patients with CAC = 0, 5% had plaque, and the only predictor of exclusively NCP was FHx [OR 2.29 (1.08-4.86)].
In symptomatic young patients undergoing CCTA, the prevalence of CAC or any coronary atherosclerosis was not negligible, and the likelihood increased with RF burden. The presence of coronary stenosis ≥50% was rare and most often accompanied by CAC >0, but there was a significant burden of NCP and LAP even within the non-obstructive group.
在≤45 岁的有症状患者中，动脉粥样硬化特征和高级斑块亚型负担尚未确定。本研究旨在通过冠状动脉计算机断层扫描血管造影（CCTA）评估有症状的年轻患者，评估冠状动脉钙（CAC）、斑块亚型和斑块负担的患病率和预测因素。
我们纳入了来自 Monetfiore 的 907 名因胸痛评估而行 CCTA 的有症状年轻患者（18-45 岁）。使用半自动软件评估 CAC、斑块亚型和负担的患病率和预测因素。在总人群（55%为女性，44%为西班牙裔）中，89%的患者 CAC = 0。CAC 或任何斑块的 CCTA 可能性随着>3 个危险因素（RFs）而增加{比值比[OR]为 7.13（2.14-23.7）和 OR 10.26（3.36-31.2）}。137 名（15%）患者存在任何斑块；最强的独立预测因素是年龄≥35 岁[OR 3.62（2.05-6.41）]和早发性冠心病家族史（FHx）[OR 2.76（1.67-4.58）]。狭窄≥50%的情况很少见（1.8%），其中 31%的患者 CAC = 0。即使在有非阻塞性狭窄的患者中，也可看到明显的非钙化斑块（NCP，37.2%）和低衰减斑块（LAP，4.24%）负担。在 CAC = 0 的患者中，有 5%的患者有斑块，唯一预测完全 NCP 的因素是 FHx[OR 2.29（1.08-4.86）]。
在接受 CCTA 的有症状年轻患者中，CAC 或任何冠状动脉粥样硬化的患病率不容忽视，并且随着 RF 负担的增加而增加。≥50%的冠状动脉狭窄很少见，并且大多数情况下伴有 CAC>0，但即使在非阻塞性组中，NCP 和 LAP 的负担也很大。
