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Stenosis degree and plaque burden differ between the major epicardial coronary arteries supplying ischemic

Tanja Kero1, Juhani Knuuti2, Sarah Bär3

  • 1Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|August 11, 2025
PubMed

Insights

The left anterior descending artery shows more severe stenosis and plaque buildup than other coronary arteries, impacting myocardial ischemia. Plaque burden, particularly noncalcified plaque, predicts ischemia across all major arteries.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Atherosclerosis Research

Background:

  • Coronary artery disease (CAD) characterization remains incomplete regarding differences in stenosis and plaque burden across major epicardial arteries supplying ischemic territories.
  • Understanding these variations is crucial for accurate diagnosis and risk stratification in patients with suspected obstructive coronary artery disease.

Purpose of the Study:

  • To investigate and compare coronary artery stenosis, plaque burden, and composition among the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) in patients with myocardial ischemia.
  • To determine the predictive value of stenosis and plaque characteristics for myocardial ischemia across different coronary arteries.

Main Methods:

  • A cohort of 837 symptomatic patients underwent coronary computed tomography angiography (CTA) and 15O-water positron emission tomography (PET) myocardial perfusion imaging.
  • Artificial intelligence-guided quantitative computed tomography (AI-QCT) was employed to analyze coronary CTA for stenosis and atherosclerotic plaque characteristics (e.g., percent atheroma volume [PAV], percent noncalcified plaque volume [NCPV], percent calcified plaque volume [CPV]).
  • Myocardial ischemia was defined by regional PET perfusion deficits in the LAD, LCX, and RCA territories.

Main Results:

  • The LAD artery demonstrated significantly higher stenosis, absolute plaque volume, and normalized plaque volume compared to the LCX and RCA (P < .001).
  • Multivariable logistic regression revealed that diameter stenosis (P = .001–.015), PAV (P < .001), and NCPV (P = .001–.017) were associated with ischemia across all three arteries.
  • Percent calcified plaque volume (CPV) was significantly associated with ischemia only in the RCA (P = .001).

Conclusions:

  • Significant differences exist in stenosis and atherosclerotic burden between the LAD and other major coronary arteries (LCX, RCA), irrespective of ischemic status.
  • Luminal narrowing and plaque burden, predominantly noncalcified plaque, are independent predictors of myocardial ischemia in all three main coronary arteries.
  • A substantial proportion of vessels supplying ischemic territories exhibit low stenosis and plaque burden, particularly in the LCX and RCA, highlighting limitations in predicting ischemia based solely on diameter stenosis and PAV.
Abstract

Keywords:
Artificial intelligenceCoronary computed tomography angiographyCoronary plaqueIschemiaPositron emission tomography

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