According to a new study published online in the journal Radiology, coronary computed tomography angiography (CCTA) is an effective tool for determining the risk of heart attacks and other adverse cardiac events in patients with suspected coronary artery disease but no treatable risk factors, such as high cholesterol or high blood pressure.

CCTA should be considered as an appropriate first line test for patients with atypical chest pain and suspected, but unconfirmed, coronary artery disease, said the study¹s lead author, Jonathon Leipsic, MD, FRCPC, from the University of British Columbia in Vancouver.

CCTA is a noninvasive test that has shown high accuracy for the diagnosis or exclusion of coronary artery disease in individuals. However, referral for patients with suspected coronary artery disease is often based on clinical risk factor scoring. Less is known about the prognostic value of CCTA in individuals with no medically modifiable risk factors.

Leipsic and colleagues correlated CCTA findings with the risk of major adverse cardiac events in 5,262 patients with suspected coronary artery disease but no medically modifiable risk factors. After an average follow-up of 2.3 years, 104 patients had experienced a major adverse cardiovascular event. The researchers identified a high prevalence of coronary artery disease in the study group, despite the absence of modifiable risk factors. More than one-quarter of the patients had non-obstructive disease or disease related to the buildup of plaque in the arteries, and another 12 percent had obstructive disease with a greater than 50 percent narrowing in a coronary artery.
“We found that patients with narrowing of the coronary arteries on CT had a much higher risk of an adverse cardiac event,” Leipsic said. “This was true even for those without a family history of heart disease.”

Both symptomatic and asymptomatic patients with obstructive disease faced an increased risk for a major cardiac event. In contrast, the absence of coronary artery disease on CCTA was associated with a very low risk of a major event. The researchers continue to study the CONFIRM data with the aim to learn more about the relationship between plaque and heart attacks and the longer-term outlook for patients with coronary artery disease.

[source: Radiology]