Background
Premature and very premature coronary artery disease (CAD) are each associated with rapid disease progression and significant cardiovascular morbidity and mortality. Affected patients usually have substantial modifiable cardiovascular risk factors. Central Australia has Australia’s highest rate of acute myocardial infarction (AMI). Premature atherosclerotic plaque can be safely demonstrated using computed tomography coronary angiography (CTCA).
Method
A retrospective cohort study of patients undergoing CTCA in Central Australia between July 2021 and July 2024 demonstrated the prevalence and burden, modifiable and non-modifiable risk factors and composite cardiovascular outcomes in patients with premature and very premature CAD. Premature CAD was defined as CAD in men <55 years or women <65 years, while very premature CAD was defined as CAD in men <40 years or women <45 years.
Results
We demonstrated that 215/519 patients (41%) in the premature cohort had CAD with significant predictors including age, male gender, indigenous ethnicity, troponin positivity, low-density lipoprotein cholesterol (LDL-C) levels, high-density lipoprotein cholesterol (HDL-C) levels, triglyceride levels and statin use. In the very premature cohort, 47/189 (25%) had CAD. Premature CAD was not associated with greater frequency of the primary endpoint of non-fatal myocardial infarction and all-cause mortality (12/215 (6%) vs 9/304 (3%), p=0.136) but very premature CAD was (6/47 (13%) vs 6/142 (4%), p=0.037).
Conclusion
Future clinical guidelines should consider the role of CTCA in CAD detection in high-risk cohorts of younger patients. Identification of premature and very premature CAD will facilitate proactive patient-centred prevention and management strategies.