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Rapidly progressive coronary atherosclerosis in a young male: a retrospective advanced CCT phenotype analysis
Daniel Lorenzatti1, Annalisa Filtz1,2, Azeem Latib1
1Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210st Bronx, Bronx, NY, 10467, USA.
Insights
Zero coronary calcium scores may be unreliable in young, high-risk patients. This case highlights rapid progression to severe coronary artery disease, emphasizing the need for comprehensive risk assessment beyond calcium scoring.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Cardiology
Background:
- Coronary artery disease (CAD) risk stratification typically relies on coronary artery calcium (CAC) scoring.
- Non-calcified plaque, though often less emphasized in risk assessment, can drive rapid disease progression.
- Certain high-risk subgroups may present challenges to traditional risk stratification methods.
Abstract:
We present a real-life case of a very young man with multiple risk factors who progressed rapidly from minimally obstructive non-calcified plaque on computed tomography angiography (CCTA) to severe three-vessel coronary disease presenting with STEMI. It questions the reliability of zero coronary calcium in high-risk subgroups like familial hypercholesterolemia, high Lp(a), and the young. While CCTA can accurately visualize non-calcified plaque, its interpretation requires expertise and clinical judgment should consider both imaging and clinical risk factors for management. Advanced plaque quantification, peri-coronary (PCAT), and epicardial (EAT) adipose tissue could help better-stratified patients but the evidence-based clinical application remains unknown.
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