Age related compositional plaque burden by CT in patients with future ACS

Alexander R. van Rosendael, Inge J. van den Hoogen, Fay Y. Lin, Umberto Gianni, Yao Lu, Daniele Andreini, Mouaz H. Al-Mallah, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J.W. Chow, Edoardo Conte, Ricardo C. Cury, Gudrun Feuchtner, Pedro de Araújo Gonçalves, Martin Hadamitzky, Yong Jin Kim, Jonathon A. Leipsic, Erica Maffei, Hugo Marques, Fabian PlankGianluca Pontone, Gilbert L. Raff, Todd C. Villines, Sang Eun Lee, Subhi J. Al'Aref, Lohendran Baskaran, Iksung Cho, Ibrahim Danad, Heidi Gransar, Matthew J. Budoff, Habib Samady, Renu Virmani, James K. Min, Jagat Narula, Daniel S. Berman, Hyuk Jae Chang, Leslee J. Shaw, Jeroen J. Bax

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: We examined age differences in whole-heart volumes of non-calcified and calcified atherosclerosis by coronary computed tomography angiography (CCTA) of patients with future ACS. Methods: A total of 234 patients with core-lab adjudicated ACS after baseline CCTA were enrolled. Atherosclerotic plaque was quantified and characterized from the main epicardial vessels and side branches on a 0.5 ​mm cross-sectional basis. Calcified plaque and non-calcified plaque were defined by above or below 350 Hounsfield units. Patients were categorized according to their age by deciles. Also, coronary artery calcium scores (CACS) were evaluated when available. Results: Patients were on average 62.2 ​± ​11.5 years old. On the pre-ACS CCTA, patients showed diffuse, multi-site, predominantly non-obstructive atherosclerosis across all age categories, with plaque being detected in 93.5% of all ACS cases. The proportion calcified plaque from the total plaque burden increased significantly with older presentation (10% calcification in those <50 years, and 50% calcification in those >80 years old). Patients with ACS <50 years had remarkably lower atherosclerotic burden compared with older patients, but a high proportion of high risk markers such as low-attenuation plaque. CACS was >0 in 85% of the patients older than 50 years, and in 57% of patients younger than 50 years. Conclusion: The proportion of calcified plaque varied depending on patient age at the time of ACS. Only a small proportion of plaque was calcified when ACS occurred at <50 years old, while this increased gradually with older age. Purely non-calcified atherosclerotic plaque was not uncommon in patients <50 years.

Original languageEnglish (US)
Pages (from-to)491-497
Number of pages7
JournalJournal of cardiovascular computed tomography
Issue number6
StatePublished - Nov 1 2022


  • Atherosclerosis
  • Coronary cta
  • Early detection of heart attack
  • Predictive Value of Tests
  • Cross-Sectional Studies
  • Tomography, X-Ray Computed/methods
  • Computed Tomography Angiography/methods
  • Humans
  • Middle Aged
  • Plaque, Atherosclerotic
  • Coronary Artery Disease/diagnostic imaging
  • Aged, 80 and over
  • Aged
  • Coronary Angiography/methods

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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