Korean Circ J.  2010 Sep;40(9):434-441. 10.4070/kcj.2010.40.9.434.

Subclinical Coronary Artery Disease as Detected by Coronary Computed Tomography Angiography in an Asymptomatic Population

• Lee S
• Choi EK
• Chang HJ
• Kim CH
• Seo WW
• Park JJ
• Choi SI
• Chun EJ
• Chang SA
• Kim HK
• Kim YJ
• Koo BK
• Choi DJ
• Oh B

• KMID: 1456135
• DOI: http://doi.org/10.4070/kcj.2010.40.9.434

Abstract

BACKGROUND AND OBJECTIVES
Primary prevention of coronary artery disease (CAD) has become a public health issue, according to increasing awareness of the substantial risks posed by asymptomatic atherosclerosis. The aims of this study were to determine the prevalence and characteristics of subclinical CAD using coronary computed tomography angiography (CCTA), and to evaluate the role of this advanced technology in identifying subclinical CAD in asymptomatic Korean individuals, compared with conventional risk stratification.
SUBJECTS AND METHODS
We enrolled 4,320 consecutive asymptomatic individuals (61% males, aged 50+/-9 years), who underwent 64-slice CCTA during a routine health check.
RESULTS
Coronary artery plaques were present in 1,053 (24%) individuals. Significant stenosis (diameter stenosis > or =50%) was identified in 139 (3%) subjects, and most of the significant lesions (87%) were located in the left anterior descending artery. CCTA revealed noncalcified plaques in 5% of subjects with a coronary calcium score of zero (n=801). Although 25% (n=10) of those with noncalcified plaque had significant stenosis, most of them (90%) were classified into low- or moderate-risk groups according to National Cholesterol Education Program risk stratification guidelines. In a young population (age < or =55 years for males, < or =65 years for females), 30% of subjects with significant stenosis were classified into a low-risk group and 60% had low (0 to 100) calcium scores.
CONCLUSION
Subclinical CAD in asymptomatic individuals cannot be ignored for its considerable prevalence, CCTA may be helpful in identifying at-risk subclinical CAD in a noninvasive manner, especially in the young and traditionally low-risk population.

Keyword

Coronary artery disease; Primary prevention; Tomography scanners, X-ray computed

MeSH Terms

Aged
Angiography
Arteries
Atherosclerosis
Calcium
Cholesterol
Constriction, Pathologic
Coronary Artery Disease
Coronary Vessels
Humans
Male
Prevalence
Primary Prevention
Public Health
Tomography Scanners, X-Ray Computed
Calcium
Cholesterol

Figure

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  Fig. 1 Study protocol. CCTA: coronary CT angiography, AMI: acute myocardial infarction.

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  Fig. 2 Study population according to analysis of plaque characteristics. CAD: coronary artery disease.

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  Fig. 3 Conventional risk stratification according to (A) NCEP risk stratification and (B) coronary artery calcium scores (CACSs), in an asymptomatic, significantly atheroscleroticsis population identified by using CCTA. NCEP: National Cholesterol Education Program, CCTA: coronary computed tomography angiography.

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