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Relationship Between Coronary Artery Calcium and Atherosclerosis Progression Among Patients With Suspected Coronary Artery Disease

 Emma J Hollenberg  ;  Fay Lin  ;  Michael J Blaha  ;  Matthew J Budoff  ;  Inge J van den Hoogen  ;  Umberto Gianni  ;  Yao Lu  ;  A Maxim Bax  ;  Alexander R van Rosendael  ;  Sara W Tantawy  ;  Daniele Andreini  ;  Filippo Cademartiri  ;  Kavitha Chinnaiyan  ;  Jung Hyun Choi  ;  Edoardo Conte  ;  Pedro de Araújo Gonçalves  ;  Martin Hadamitzky  ;  Erica Maffei  ;  Gianluca Pontone  ;  Sanghoon Shin  ;  Yong-Jin Kim  ;  Byoung Kwon Lee  ;  Eun Ju Chun  ;  Ji Min Sung  ;  Alessia Gimelli  ;  Sang-Eun Lee  ;  Jeroen J Bax  ;  Daniel S Berman  ;  Stephanie L Sellers  ;  Jonathon A Leipsic  ;  Ron Blankstein  ;  Jagat Narula  ;  Hyuk-Jae Chang  ;  Leslee J Shaw 
 JACC-CARDIOVASCULAR IMAGING, Vol.15(6) : 1063-1074, 2022-06 
Journal Title
Issue Date
Atherosclerosis* ; Calcium ; Computed Tomography Angiography / methods ; Constriction, Pathologic / complications ; Coronary Angiography / methods ; Coronary Artery Disease* / complications ; Coronary Artery Disease* / diagnostic imaging ; Coronary Artery Disease* / epidemiology ; Coronary Vessels / diagnostic imaging ; Disease Progression ; Humans ; Plaque, Atherosclerotic* ; Predictive Value of Tests ; Risk Factors
atherosclerotic plaque ; coronary artery calcium ; coronary computed tomographic angiography ; plaque progression
Background: Among symptomatic patients, it remains unclear whether a coronary artery calcium (CAC) score alone is sufficient or misses a sizeable burden and progressive risk associated with obstructive and nonobstructive atherosclerotic plaque.

Objectives: Among patients with low to high CAC scores, our aims were to quantify co-occurring obstructive and nonobstructive noncalcified plaque and serial progression of atherosclerotic plaque volume.

Methods: A total of 698 symptomatic patients with suspected coronary artery disease (CAD) underwent serial coronary computed tomographic angiography (CTA) performed 3.5 to 4.0 years apart. Atherosclerotic plaque was quantified, including by compositional subgroups. Obstructive CAD was defined as ≥50% stenosis. Multivariate linear regression models were used to measure atherosclerotic plaque progression by CAC scores. Cox proportional hazard models estimated CAD event risk (median of 10.7 years of follow-up).

Results: Across baseline CAC scores from 0 to ≥400, total plaque volume ranged from 30.4 to 522.4 mm3 (P < 0.001) and the prevalence of obstructive CAD increased from 1.4% to 49.1% (P < 0.001). Of those with a 0 CAC score, 97.9% of total plaque was noncalcified. Among patients with baseline CAC <100, nonobstructive CAD was prevalent (40% and 89% in CAC scores of 0 and 1-99), with plaque largely being noncalcified. On the follow-up coronary CTA, volumetric plaque growth (P < 0.001) and the development of new or worsening stenosis (P < 0.001) occurred more among patients with baseline CAC ≥100. Progression varied compositionally by baseline CAC scores. Patients with no CAC had disproportionate growth in noncalcified plaque, and for every 1 mm3 increase in calcified plaque, there was a 5.5 mm3 increase in noncalcified plaque volume. By comparison, patients with CAC scores of ≥400 exhibited disproportionate growth in calcified plaque with a volumetric increase 15.7-fold that of noncalcified plaque. There was a graded increase in CAD event risk by the CAC with rates from 3.3% for no CAC to 21.9% for CAC ≥400 (P < 0.001).

Conclusions: CAC imperfectly characterizes atherosclerotic disease burden, but its subgroups exhibit pathogenic patterns of early to advanced disease progression and stratify long-term prognostic risk.
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1. College of Medicine (의과대학) > Dept. of Dermatology (피부과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Sung, Ji Min(성지민)
Lee, Byoung Kwon(이병권) ORCID logo https://orcid.org/0000-0001-9259-2776
Lee, Sang Eun(이상은) ORCID logo https://orcid.org/0000-0003-4720-9955
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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