Multislice CT identifies coronary atherosclerosis in 'low-risk' patients

Multislice CT identifies coronary atherosclerosis in ‘low-risk’ patients By Reuters Health September 4, 2008 NEW YORK (Reuters Health), Sep 4 – Multislice CT (MSCT) detects proximal coronary atherosclerotic plaque or obstructive coronary artery disease (CAD) in “a significant proportion” of patients with a low or intermediate Framingham risk score, according to research conducted at the Cleveland Clinic in Ohio. “Given the potential shortcomings of Framingham-based traditional risk assessment, we wanted to know if noninvasive imaging can potentially provide incremental information,” Dr. Milind Y. Desai told Reuters Health. The study, which is published in the August issue of the American Journal of Cardiology, included 295 consecutive patients (mean age 54) with suspected cardiac symptoms, such as chest pain or dyspnea on exertion, or equivocal stress test results. Based on Framingham risk scores, 213 patients were at low 10-year risk of CHD (< 10%), 74 were at intermediate risk (10%-20%), and eight were at high risk (> 20%). Results of MSCT coronary angiography showed that “44% of patients in the low-risk group and 75% in the intermediate-risk group had evidence of proximal left anterior descending artery or left main artery plaque,” Desai said. This is a concern because “most heart attacks occur in proximal lesions that are not severe.” So why do some people ostensibly at low risk have significant coronary atherosclerosis? “Current risk prediction models are old, based predominantly on Caucasian folks in Massachusetts,” Desai explained. “They don’t take into account all risk factors, including obesity, metabolic syndrome, genetics, family history, and stress.” The investigators note that 51 patients below 55 years of age and 48 women were identified with proximal atherosclerotic plaque, but only 40% were on statin therapy. Based on current guidelines, MSCT coronary angiography may be indicated in symptomatic individuals with intermediate-risk scores, Desai said. “In certain low-risk individuals (e.g., those with a family history of premature CAD), I would clinically consider it,” he added. His group’s goal now is “to conclusively establish the long-term incremental prognostic value of CT angiography,” the investigator said. By Karla Gale Am J Cardiol 2008;102:316-320.