Coronary artery disease

Dr David Carroll and Dr Henry Knipe et al.

Coronary artery disease (CAD) is the leading cause of mortality globally. 

CAD is asymptomatic in most of the population. When severe enough it can cause angina or an acute coronary syndrome including myocardial infarction. CAD may also present with heart failure or sudden cardiac death. 

CAD is primarily due to atherosclerosis, an inflammatory process that leads to atheroma development and remodelling/stenosis of the coronary arteries. A stenosis of >50% of diameter or >75% cross-section diameter reduction can lead to angina. Thrombus formation after plaque disruption can lead to acute coronary syndrome 1,2

  • non-modifiable: family history, age, male sex 1
  • modifiable: hypercholesterolemia, left ventricular hypertrophy, obesity, hypertension, diabetes, sedentary lifestyle, smoking, alcohol 1

There are a variety of techniques to image coronary artery disease including both anatomical and functional modalities. Coronary angiography has been the mainstay for many years, but in certain patient groups is being replaced by non-invasive imaging such as coronary CT angiography (cCTA).

There are several appropriate clinical indications for the performance of coronary CTA 8

Haemodynamically significant stenoses are those >70% for all coronary arteries, except the left main coronary artery where >50% stenosis is considered significant 7.

In a post-hoc analysis of prospective acquired data, a cutoff value > -70 HU of the perivascular fat attenuation index (FAI) around the proximal right coronary artery was found to be predictive of increased all-cause mortality 10.

The recently proposed SCCT grading scale for stenosis severity assesses the degree of luminal diameter stenosis 6:

  • 0% = no visible stenosis
  • 1-24% = minimal stenosis
  • 25-49% = mild stenosis
  • 50-69% = moderate stenosis
  • 70-99% = severe stenosis
  • 100% = occlusion
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Article information

rID: 43406
System: Vascular, Cardiac
Synonyms or Alternate Spellings:
  • Coronary heart disease (CHD)
  • Coronary arterial disease
  • Coronary artery disease (CAD)
  • Coronary arterial disease (CAD)

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  • LAD soft atheroma
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