Age-Related Distribution and Severity of Coronary Artery Stenosis Assessed by 640-Row Coronary Computed Tomography Angiography: A Cross-Sectional Study

Background: Coronary computed tomography angiography (CCTA) is an established noninvasive imaging modality for evaluating suspected coronary artery disease (CAD). However, data describing the pattern of coronary stenosis and the extent of significant disease in patients undergoing modern 640-row CCTA remain limited. Methods: This single-center cross-sectional study included 390 consecutive patients with suspected CAD who underwent 640-row CCTA between May 2021 and May 2022. Stenosis severity was assessed according to the coronary segment and major vessel involvement. Clinically significant stenosis was defined as luminal narrowing of ≥50% in the left main coronary artery (LM) or ≥70% in the left anterior descending, right coronary, or left circumflex arteries. The extent of significant CAD was categorized as single-vessel disease, two-vessel disease, or left main/three-vessel disease. Results: The mean age of the study population was 58.4±10.4 years, and 209 patients (53.6%) were men. Women were older than men (61.4±10.3 vs. 55.8±10.1 years, p<0.001). Myocardial bridging was identified in 115 patients (29.5%) and was more common in men than in women (73/209 (34.9%) vs. 42/181 (23.2%), p=0.011). Across all coronary segments, most lesions were classified as none-to-moderate stenosis, whereas severe stenosis and total occlusion were less frequent. CCTA-detected significant stenosis was observed in 120 patients (30.8%), while 270 patients (69.2%) had non-significant stenosis. Single-vessel disease, two-vessel disease, and left main or three-vessel disease were present in 46 (11.8%), 41 (10.5%), and 33 patients (8.5%), respectively. Patients older than 60 years had significantly higher proportions of significant stenosis in the left main artery, left anterior descending artery (LAD), right coronary artery (RCA), and left circumflex artery (LCx) (all p<0.001). Among patients with significant CAD, the extent of disease differed by sex in the older age group but not in the younger age group. Conclusions: In patients undergoing 640-row CCTA for suspected CAD, significant coronary stenosis was common and strongly associated with older age. Older men with significant CAD were more likely to have extensive disease, while myocardial bridging was more frequent and common in men. These findings highlight the clinical value of 640-row CCTA in the detailed characterization of coronary stenosis patterns in routine clinical practice.