Abstract Background Coronary computed tomography angiography (CCTA) provides for detailed visualization of coronary anatomy and (non-)obstructive plaques, enabling the diagnosis of coronary artery disease (CAD). Although established risk scores and percentile distribution exist for calcified plaque components, e.g., the Agatston score, much less data is available regarding the overall prevalence of coronary plaques in a representative patient population undergoing CCTA, particularly regarding the distribution of non-calcified plaque components. Purpose This study aims to analyze coronary plaque characteristics in a German outpatient cohort and to establish reference plaque scores and percentiles specifically for non-calcified plaque components. Methods This analysis included all patients who underwent CCTA using a third-generation dual-source scanner between July 2017 and June 2020 for suspected coronary artery disease. Quantitative assessment and characterization of atherosclerotic plaques were conducted using validated semi-automated software. Plaque analysis was performed on each vessel individually, measuring plaque volume, and plaque burden, with differentiation among total, calcified, fibrotic, and low-attenuation plaque components. Results The analysis included 5,412 patients (60.8% male) with a mean age of 63 ± 11.5 years. Among these, 1,783 patients (32.9%) showed no evidence of CCTA-defined coronary atherosclerosis, while 3,629 patients (67.1%) exhibited coronary plaques. Obstructive CAD was identified in 1,584 patients (29.3%) of the total study population. Notably, in 99 patients (1.8%), exclusively non-calcified plaque was determined without any calcified components. The highest recorded coronary plaque burden in a single patient was 3,278 mm³ for total coronary plaques, including 2,025 mm³ for calcified, 1,777 mm³ for fibrotic, and 449 mm³ for low-attenuation plaque components. Among patients with coronary atherosclerosis, the greatest mean plaque burden was found in the left anterior descending coronary artery (69.6%). In the total population, the 50th, 70th, and 90th percentile values for total coronary plaque burden were 28.8 mm³, 102.2 mm³, and 302.0 mm³, respectively. For fibrotic plaque components, these values were 3.8 mm³, 26.5 mm³, and 102.4 mm³; and for low-attenuation plaques, they were 0 mm³, 0.4 mm³, and 5.1 mm³. Conclusions This study provides the first comprehensive data on coronary plaque burden and composition in a large German outpatient cohort undergoing CCTA. The findings underscore the value of CCTA in detecting non-stenosing plaques. Although only 29.3% of patients had obstructive CAD, 67.1% of those undergoing CCTA due to symptoms suggestive of CAD showed evidence of coronary plaques. By establishing reference values and percentiles for total, fibrotic, and low-attenuation plaque burdens, this study significantly advances our understanding of coronary plaque distribution in the general population.Percentile distribution of plaque burden
Breitbart et al. (Sat,) studied this question.