Clinicians who have trouble identifying patients with cardiovascular disease might look to a new tool to help them predict which patients are at risk for a heart attack.

According to a new study in the journal Radiology, coronary computed tomography angiography (CCTA), a noninvasive test commonly used to diagnose coronary artery disease (CAD), is also effective in determining the risk of heart attack and other adverse cardiac events in patients with suspected CAD but who lack treatable risk factors.

Normally, patients at risk for heart disease have high blood pressure or a history of smoking, for example. Risk factors that are modifiable. But in some cases, patients will have symptoms but none of the other risk factors associated with CAD. Currently, no model exists to help clinicians identify these patients who might be at risk for a heart attack.
"What we found was that those patients with significant coronary disease on CCTA had an adverse prognosis despite the fact they had no modifiable cardiovascular risk factor," Dr. Jonathon Leipsic, lead author of the study, told DOTmed News. "We thought this to be quite interesting."

Leipsic and his research team culled the data from a confirmed registry of roughly 35 thousand men and women who ranged in age, ethnicity and risk factors for CAD and CCTA evaluation.

"My particular analysis was on those without known modifiable cardiovascular risk factors, which is a difficult patient population to evaluate because these patients don't have traditional risk factors," said Leipsic.

Exactly 5,262 patients from the registry evaluated with CCTA had suspected CAD but no medically modifiable risk factors. One hundred and four of those patients experienced a major adverse cardiovascular event after an average follow-up of 2.3 years, according to the study.

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 the coronary artery.

Other tests used to detect CAD, like a treadmill study, may not be able to detect multiple segments of plaque, according to Leipsic.

"For someone with chest pain not yet diagnosed, I think cardiac CT is a very powerful tool because it really discerns those that are at risk versus those that are not at risk, and I think that's an important question to answer in a way other tests may not be able to," he said.

CCTA would then be able to help clinicians determine which patients would benefit from more intensive therapy. Leipsic and his team are continuing their research through a longer-term analysis of the prognostic value of CCTA.

Although heart disease is the leading cause of death for both men and women in the U.S., many policy makers focused on decreasing health care costs while increasing quality are concerned with the overuse of CT scanning to detect heart disease. Roughly half a million Americans undergo CCTA scans every year.

More Industry Headlines