Multislice Computed Tomography in an Asymptomatic High-Risk Population

Abstract

Approximately 50% of all acute coronary syndromes occur in previously asymptomatic patients. This study evaluated the value of multislice computed tomography for early detection of significant coronary artery disease (CAD) in high-risk asymptomatic subjects. One hundred sixty-eight asymptomatic subjects with >1 major risk factor (hypertension, diabetes, hypercholesterolemia, family history, or smoking) and an inconclusive or unfeasible noninvasive stress test result (stress electrocardiography, echocardiography, or nuclear scintigraphy) were evaluated in an outpatient setting. After clinical examination and laboratory risk analysis, all patients underwent multislice computed tomographic (MSCT) coronary angiography within 1 week. In all subjects, conventional coronary angiography was also carried out. Multislice computed tomography displayed single-vessel CAD in 16% of patients, 2-vessel CAD in 7%, and 3-vessel CAD in 4%. Selective coronary angiography confirmed the results of multislice computed tomography in 99% of all patients. Sensitivity and specificity of MSCT coronary angiography were 100% and 98%, respectively, with a positive predictive value of 95% and a negative predictive value of 100%. Multislice computed tomographic (MSCT) coronary angiography is a relatively new noninvasive technique to define coronary artery disease (CAD). It is considered 1 of the most significant advances in cardiac imaging technology. Previous studies in symptomatic patients have reported an excellent sensitivity and specificity and negative predictive value of multislice computed tomography, 1-5 much better than those of other noninvasive tests, such as exercise electrocardiography and thallium scintigraphy. 6 -9 However, there are no data available on the extent and severity of CAD in a high-risk asymptomatic population, particularly by noninvasive means. We postulated that multislice computed tomography, if accurate, could be used as a potent noninvasive diagnostic tool to manage patients at high risk for coronary atherosclerosis. 10,11 This study evaluated the value of multislice computed tomography for early detection of significant CAD in asymptomatic subjects with conventional CAD risk factors and inconclusive or unfeasible noninvasive stress test results. MethodsPatient population: We enrolled 168 consecutive asymptomatic subjects from June 2004 to April 2005 (89 men, 27 women; mean age 60 Ϯ 7 years, range 36 to 70) who were evaluated in a primary prevention program in an outpatient setting. All subjects were evaluated with clinical examination and laboratory risk analysis. Criteria for inclusion in this study were an age Ͻ70 years, absence of a previous diagnosis or symptoms of CAD (such as chest pain), presence of Ն1 CAD risk factor, and an inconclusive or unfeasible stress test result (stress electrocardiography, echocardiography, or nuclear scintigraphy). Diagnosis of diabetes was based on criteria of the American Diabetes Association, i.e., symptoms of diabetes plus random plasma glucose concentration Ն200 mg/dl (1...

Coronary Computed Tomography Angiography as a Screening Tool for the Detection of Occult Coronary Artery Disease in Asymptomatic Individuals

“…Despite the absence of evidence, the use of CTA as a screening tool has been already initiated, not only through physician decision-making but through the mechanism of self-referral (7,8).…”

Role of Coronary Artery Calcium Score and Coronary CT Angiography in the Diagnosis and Risk Stratification of Individuals with Suspected Coronary Artery Disease

“…These studies, although limited to a few hundred patients with clinical predictors of CAD, discovered a high prevalence of occult atherosclerosis in study individuals, many of whom might benefit from intervention. Early documentation of CAD impacted therapeutic decision making and led to intensification of management [67][68][69]. Another study of patients with type 2 diabetes found that 26% had a significant stenosis on cardiac CT and 45% had a combination of noncalcified and calcified plaques [70].…”

Early detection of coronary artery disease by 64-slice multidetector computed tomography in asymptomatic hypertensive high-risk patients

“…In particular, the prediction and prevention of acute cardiac events in high-risk patients require the assessment of the extent and composition of atherosclerotic coronary lesions. These information can now be noninvasively obtained by MDCT in the preclinical phase [4,9].…”

“…In asymptomatic high-risk subjects, conversely, the role of this emerging noninvasive technology remains unclear [4][5][6]. The possibility exists, however, that the new 64-slice MDCT might represent an ideal noninvasive imaging technique to discover if and to which extent coronary arteries are affected by atherosclerotic plaques in many apparently healthy subjects [7,8] who could be considered at high-risk of coronary artery disease because of gender, age, high blood pressure, elevated cholesterol level or smoking [9,10].…”