Distribution, extent, and calculated age of initiation of coronary artery calcification

Purpose: The aim of this study was to characterize the distribution of coronary plaque burden and gender differences in the estimated age of coronary artery calcium (CAC) initiation in patients with moderate or low probability of coronary artery disease using cardiac computed tomography imaging. Material and methods: CAC was measured using the Agatston method. The patients were categorized into risk categories based on CAC score (CACs) and based on the number of involved coronary vessels. We investigated CAC distribution and plaque burden throughout the coronary vasculature in both sexes. Furthermore, we calculated the calcification initiation in each main coronary artery territory, assuming that average annual CACs progression is 25% per year. Results: Among the 937 affected vessels, calcifications were most prevalent in the left anterior descending artery (LAD), with a higher plaque burden ratio. Among patients with a low CAC burden, the LAD was the most frequently involved vessel. Analysis of the estimated age of CAC initiation reveals that calcification begins to develop earlier in the LAD than in other coronary territories in both sexes. Involvement of the second coronary artery territory after one-vessel disease can be expected after a median of 4.5 years (range 2.2-8), with no significant difference between men and women. Conclusions: Calcified plaque was most commonly identified in the LAD. CAC occurs earlier in the LAD than in other coronary arteries. The particular susceptibility to calcification of LAD is not related to gender.