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Updated: Sep 25, 2025
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Marked variation in atherosclerotic plaque progression between the major epicardial coronary arteries
A Maxim Bax1, Fay Y Lin1, Alexander R van Rosendael2
1Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 East 69th Street, Suite 108, New York, NY 10021, USA.
Insights
Atherosclerosis progresses differently across major coronary arteries. The left anterior descending (LAD) artery shows faster plaque buildup and higher risk of obstructive disease compared to the left circumflex (LCx) and right coronary artery (RCA).
Area of Science:
- Cardiovascular Imaging and Atherosclerosis Research
- Coronary Artery Disease Progression Analysis
Background:
- Atherosclerosis is a progressive disease, but its development and associated event risks differ among the left circumflex (LCx), right coronary artery (RCA), and left anterior descending (LAD) arteries.
- Understanding these variations is crucial for accurate risk stratification and management of coronary artery disease (CAD).
Purpose of the Study:
- To investigate and compare the distinct patterns of progressive atherosclerotic disease alterations within the LCx, LAD, and RCA.
- To analyze differences in plaque volume progression, stenosis development, and formation of high-risk plaque (HRP) features across these three major coronary arteries.
Main Methods:
- Analysis of data from a prospective, international registry of patients undergoing serial computed tomography coronary angiography (CCTA) at a median 3.3-year interval.
- Quantitative assessment of total and compositional plaque volume progression, comparison of stenosis ≥50%, and incidence of new HRP lesions.
- Statistical modeling (generalized estimating equations, marginal Cox regression) adjusted for baseline risk factors, statin use, and plaque burden.
Main Results:
- Plaque progression was observed less frequently in the LCx (41.0%) compared to the RCA (52.7%) and LAD (77.4%).
- The LAD showed significantly higher odds for annual plaque burden increase and a greater risk of progression to obstructive CAD compared to the LCx.
- New HRP lesions were least common in the LCx (3.4%), intermediate in the RCA (8.1%), and most frequent in the LAD (10.1%).
Conclusions:
- Significant variations exist in atherosclerotic plaque progression patterns among the LCx, LAD, and RCA.
- The LAD demonstrates a more aggressive disease progression profile, including increased plaque burden and higher rates of obstructive disease and HRP formation.
- These findings suggest differing disease stages or pathogenic environments across the major coronary arteries, necessitating tailored diagnostic and therapeutic approaches.
Aims:
Atherosclerosis develops progressively and worsens over time, yet event risk patterns vary in the left circumflex (LCx), right coronary artery (RCA) and left anterior descending (LAD). The aim of this analysis was to examine varying progressive disease alterations between the three major coronary arteries.
Methods And Results:
Patients were included from a prospective, international registry of consecutive patients who underwent serial CCTA at a median interval of 3.3 years. Annual progression of quantitative total and compositional plaque volume were compared between the three coronary arteries (LCx, LAD, and RCA). Other analyses compared stenosis ≥50% and new high-risk plaque (HRP; ≥2 of the following: spotty calcification, positive remodelling, napkin-ring sign, and low-attenuation plaque) on follow-up. Generalized estimating equations and marginal Cox regression models were used to compare progression, with covariate adjustment by the baseline atherosclerotic cardiovascular disease risk score, statin use, and plaque burden. Quantitative plaque measurements were calculated in 1344 patients (age 60 ± 9 years, 57% men). Plaque progression occurred less often in the LCx (41.0%) as compared to the RCA (52.7%) and LAD (77.4%, P < 0.001). Odds for annual plaque burden increase ≥population mean were 1.98- and 1.43-fold as high in the LAD (P < 0.001) and RCA (P < 0.001) as compared to the LCx. Similarly, the LAD was associated with a 2.45 higher risk of progression to obstructive CAD (P < 0.001), as compared to the LCx; with no differences between the RCA and LCx (P = 0.13). New HRP lesions formed least often in the LCx (3.4%), followed by the RCA (8.1%) and most often in the LAD (10.1%; P < 0.001).
Conclusions:
Our findings reveal novel insights into varied patterns of atherosclerotic plaque progression within the LCx as compared to the other epicardial coronary arteries. These varied patterns reflect differing stages in the disease process or differing pathogenic milieu across the coronary arteries.
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