Win an All-Access Pass!
Become a new yearly Curie (Radium) or Roentgen (Gold) Radiopaedia Supporter during December and be in the running to win one of four 12-month All-Access Passes. Find out more.

Coronary artery disease

Assoc Prof Craig Hacking 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 remodeling/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

Article information

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

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • LAD soft atheroma
    Case 1: CTCA with mild LMCA soft plaque
    Drag here to reorder.
  • Case 2: MPS
    Drag here to reorder.
  • Case 3: CTCA with moderate LAD stenosis
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.