Coronary plaque burden and composition in an ESC guideline-selected outpatient CCTA cohort: age- and sex-specific percentile distributions.
BACKGROUND AND AIMS Coronary computed tomography angiography (CCTA) as first-line diagnostic tool for suspected coronary artery disease (CAD) offers detailed assessment of coronary plaque, yet data on non-calcified components remain limited. This study aims to analyze total coronary plaque burden as well as non-calcified plaque characteristics in an ESC-guideline-selected cohort and to establish age- and sex-specific percentile distributions and benchmark values for quantitative plaque assessment. METHODS All patients undergoing CCTA for a clinical indication at a German outpatient institution between July 2017 and June 2020 were included. Plaque analysis using validated semi-automated software was performed on all coronary arteries; plaque burden was measured with differentiation among total, calcified, non-calcified, and low-attenuation components. RESULTS Of 5412 patients, coronary plaques were present in 67.1% of patients, with obstructive CAD in 29.3%. For example, the 50th, 75th, and 90th percentile values for total coronary plaque burden were 28.8 mm3, 130.2 mm3, and 302.0 mm3, respectively. Total plaque burden showed strong diagnostic performance for obstructive CAD, with optimal cut-off values of 68.45 mm3 in males (sensitivity 0.89, specificity 0.74) and 21.18 mm3 in females (sensitivity 0.93, specificity 0.77) showing the best discriminatory performance within the present cohort. Within this cohort, plaque burdens below 22.0 mm3 in males and 12.4 mm3 in females were associated with a false-negative rate below 5% for the presence of obstructive CAD. CONCLUSIONS This study provides novel insights into the prevalence and distribution of coronary plaque burden in a large outpatient cohort undergoing CCTA according to current ESC guideline recommendations. The presented age- and sex-specific percentile distributions provide benchmark values for quantitative plaque assessment in a real-world CCTA population and may facilitate standardized reporting and future outcome-based investigations of coronary plaque burden and composition.