CCTA delivers value, even when treating low-risk patients with no history of CAD
The rise of coronary CT angiography (CCTA) is one of healthcare’s biggest ongoing trends, providing care teams all over the world with a noninvasive way to evaluate a patient’s cardiovascular health. When it comes to using CCTA to evaluate low-risk individuals without known coronary artery disease (CAD), however, less its known about the modality’s value. The team behind a new analysis in JAMA Cardiology aimed to change that.[1]
“Advancements in CCTA image analysis allow for precise quantification of total plaque volume (TPV) and its subcomponents, including calcified, noncalcified and low attenuation plaque volume,” wrote first author Júlia Karády, MD, PhD, MPH, an imaging specialist with Harvard Medical School and Massachusetts General Hospital, and colleagues. “In patients with known or advanced disease, these more detailed measures of atherosclerotic plaque characteristics were shown to improve prediction of major adverse cardiovascular events (MACE) beyond traditional cardiovascular risk factors and qualitative CCTA findings … However, there has been limited research on the value of quantitative plaque metrics among patients at lower risk for atherosclerotic cardiovascular disease or those with early disease for whom risk assessment is an essential guide to the initiation and escalation of preventive therapies.”
To learn more, Karády et al. explored data from PROMISE, a multicenter randomized study of more than 10,000 patients. The group focused exclusively on more than 4,000 PROMISE patients who underwent CCTA at one of 193 facilities throughout North America. All patients were symptomatic, but presented with no known history of CAD. The mean age was 60.4 years old, 51.5% were women and the median total plaque volume (TPV) was 39.8 mm3.
The median follow-up period was 25 months. For the sake of this analysis, a MACE was defined as death, nonfatal myocardial infarction or an unstable angina-related hospitalization.
Overall, TPV ≥87 mm, total plaque burden ≥35% and noncalcified plaque burden ≥20% were all associated with a heightened MACE risk. These trends were true even if the patient was on statin therapy.
The group did note that these thresholds were “relatively low” compared to previous studies; additional research is still needed to validate them in other patient populations. Even with that observation in mind, however, the findings highlight the exceptional CCTA can provide to care teams when even low-risk heart patients undergo a quantitative plaque evaluation.
“The clinical importance of these findings may lie in their independent prediction of MACE and in their relatively low quantitative thresholds for higher risk, though further validation is required,” the authors added.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.