CT angiography helps predict heart attack risk

February 19, 2013

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, according to a new study published online in the journal Radiology.

"CCTA should be considered as an appropriate first- line test for patients with atypical chest pain and suspected but not confirmed ," said the study's lead author, Jonathon Leipsic, M.D., FRCPC, from the University of British Columbia in Vancouver.

Heart disease is the leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. Treatment often involves addressing modifiable such as elevated cholesterol, , diabetes and smoking. However, some risk factors, like family history, are not modifiable, and no risk models exist to help guide clinicians to identify those symptomatic patients without cardiac risk factors who are at an increased risk of death and .

"This scenario, where patients are symptomatic but have no , comes up often in clinical practice," Dr. Leipsic said. "We lack a good tool to stratify these patients into risk groups."

CCTA is a noninvasive test that has shown high accuracy for the diagnosis or exclusion of 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.

In the first study of its kind, Dr. Leipsic and colleagues correlated CCTA findings with the risk of major adverse in 5,262 patients with suspected coronary artery disease but no medically modifiable risk factors. They culled the data from the Evaluation For Clinical Outcomes: An International Multicenter (CONFIRM) registry.

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," Dr. 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 findings highlight the need for refinement in the evaluation of individuals who may be missed by traditional methods of coronary artery disease evaluation.

"If a patient shows up with vague symptoms and no medically modifiable risk factors, doctors often dismiss them or do a treadmill test, which won't identify atherosclerosis and only has a modest sensitivity for detecting obstructive disease," Dr. Leipsic said.

CCTA could help address this problem, Dr. Leipsic added, by helping to diagnose or rule out coronary artery disease and identifying those who may benefit from more intensive therapy.

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.

"We are now collecting data to determine the prognostic value of CCTA after five years or more of follow-up, which will be very important for the field," Dr. Leipsic said.

Explore further: CT angiography improves detection of heart disease in African-Americans

Related Stories

CT angiography improves detection of heart disease in African-Americans

June 28, 2011
Researchers may have discovered one reason that African Americans are at increased risk for heart attacks and other cardiovascular events.

Heart attack risk differs between men and women

November 30, 2011
Findings on coronary CT angiography (CTA), a noninvasive test to assess the coronary arteries for blockages, show different risk scenarios for men and women, according to a study presented today at the Radiological Society ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.