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Impact of age on coronary artery plaque progression and clinical outcome: A PARADIGM substudy
Authors:Minkwan Kim  Seung-Pyo Lee  Soongu Kwak  Seokhun Yang  Yong-Jin Kim  Daniele Andreini  Mouaz H Al-Mallah  Matthew J Budoff  Filippo Cademartiri  Kavitha Chinnaiyan  Jung Hyun Choi  Edoardo Conte  Hugo Marques  Pedro de Araújo Gonçalves  Ilan Gottlieb  Martin Hadamitzky  Jonathon A Leipsic  Erica Maffei  Hyuk-Jae Chang
Institution:1. Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Cardiology, Erlangen, Germany;2. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA;1. Division of Cardiology, Department of Medicine, Duke University Medical Center, United States;2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, United States;3. Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, United States;4. Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, United States;1. Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany;2. Department of Cardiology, University Medical Center Mainz, Johannes-Gutenberg University Mainz, Mainz, Germany
Abstract:BackgroundThe association of age with coronary plaque dynamics is not well characterized by coronary computed tomography angiography (CCTA).MethodsFrom a multinational registry of patients who underwent serial CCTA, 1153 subjects (61 ± 5 years old, 61.1% male) were analyzed. Annualized volume changes of total, fibrous, fibrofatty, necrotic core, and dense calcification plaque components of the whole heart were compared by age quartile groups. Clinical events, a composite of all-cause death, acute coronary syndrome, and any revascularization after 30 days of the initial CCTA, were also analyzed. Random forest analysis was used to define the relative importance of age on plaque progression.ResultsWith a 3.3-years’ median interval between the two CCTA, the median annual volume changes of total plaque in each age quartile group was 7.8, 10.5, 10.8, and 12.1 mm3/year and for dense calcification, 2.5, 4.6, 5.4, and 7.1 mm3/year, both of which demonstrated a tendency to increase by age (p-for-trend = 0.001 and < 0.001, respectively). However, this tendency was not observed in any other plaque components. The annual volume changes of total plaque and dense calcification were also significantly different in the propensity score-matched lowest age quartile group versus the other age groups as was the composite clinical event (log-rank p = 0.003). In random forest analysis, age had comparable importance in the total plaque volume progression as other traditional factors.ConclusionsThe rate of whole-heart plaque progression and dense calcification increases depending on age. Age is a significant factor in plaque growth, the importance of which is comparable to other traditional risk factors.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifiers: NCT02803411.
Keywords:Coronary artery disease  Computed tomography  Aging  atherosclerotic plaque  Disease progression
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