Aims The atherosclerotic profile and advanced plaque subtype burden in symptomatic patients ≤45 years old have not been established. This study aimed to assess the prevalence and predictors of coronary artery calcium (CAC), plaque subtypes, and plaque burden by coronary computed tomography angiography (CCTA) in symptomatic young patients. Methods and Results We included 907 symptomatic young patients (18-45 years) from Montefiore undergoing CCTA for chest pain evaluation. Prevalence and predictors of CAC, plaque subtypes, and burden were evaluated using semi-automated software. In the overall population (55% female and 44% Hispanic), 89% had CAC = 0. The likelihood of CAC or any plaque by CCTA increased with >3 risk factors (RF, OR 7.13 [2.14-23.7] and OR 10.26 [3.36-31.2], respectively). Any plaque by CCTA was present in 137 (15%); the strongest independent predictors were age ≥35 years (OR 3.62 [2.05-6.41]) and family history of premature CAD (FHx) (OR 2.76 [1.67-4.58]). Stenosis ≥50% was rare (1.8%), with 31% of those having CAC = 0. Significant non-calcified (NCP, 37.2%) and low-attenuation (LAP, 4.24%) plaque burdens were seen, even in those with non-obstructive stenosis. Among patients with CAC = 0, 5% had plaque, and the only predictor of exclusively non-calcified plaque was FHx (OR 2.29 [1.08-4.86]). Conclusions In symptomatic young patients undergoing CCTA, the prevalence of CAC or any coronary atherosclerosis was not negligible, and the likelihood increased with RF burden. The presence of coronary stenosis ≥50% was rare and most often accompanied by CAC > 0 but there was a significant burden of NCP and LAP even within the non-obstructive group.

中文翻译：

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18-45 岁患者危险因素、冠状动脉钙和 CCTA 斑块特征之间的相互作用

目的 ≤45 岁有症状患者的动脉粥样硬化特征和晚期斑块亚型负担尚未确定。本研究旨在通过冠状动脉计算机断层扫描血管造影（CCTA）在有症状的年轻患者中评估冠状动脉钙（CAC）、斑块亚型和斑块负荷的患病率和预测因素。方法和结果 我们纳入了来自 Montefiore 的 907 名有症状的年轻患者（18-45 岁），接受 CCTA 进行胸痛评估。使用半自动化软件评估 CAC、斑块亚型和负担的患病率和预测因子。在总体人群（55% 女性和 44% 西班牙裔）中，89% 的人 CAC = 0。CCTA 发现 CAC 或任何斑块的可能性随着 > 3 个危险因素而增加（RF、OR 7.13 [2.14-23.7] 和 OR 10.26）分别为[3.36-31.2]）。 137 例 (15%) 中存在 CCTA 检测的任何斑块；最强的独立预测因素是年龄≥35岁（OR 3.62 [2.05-6.41]）和早发CAD家族史（FHx）（OR 2.76 [1.67-4.58]）。狭窄≥50%的情况很少见（1.8%），其中 31% 的患者 CAC = 0。即使在那些患有非阻塞性狭窄。在 CAC = 0 的患者中，5% 存在斑块，完全非钙化斑块的唯一预测因子​​是 FHx（OR 2.29 [1.08-4.86]）。结论 在接受 CCTA 的有症状年轻患者中，CAC 或任何冠状动脉粥样硬化的患病率不可忽视，并且这种可能性随着 RF 负担的增加而增加。冠状动脉狭窄≥50%的情况很少见，最常伴有CAC>50%。 0，但即使在非阻塞性组中，NCP 和 LAP 的负担也很重。