Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals.
OBJECTIVE
The purpose of this study was to evaluate the prevalence of occult coronary artery disease (CAD) with coronary computed tomography angiography (CTA) to characterize plaque composition and to evaluate the potential of this new technology to impact risk stratification in asymptomatic middle-aged subjects.


BACKGROUND
There is a paucity of information regarding the role of CTA for the detection of occult CAD in asymptomatic individuals.


METHODS
We consecutively enrolled 1,000 middle-aged asymptomatic subjects (age 50 +/- 9 years, 63% men) who underwent CTA (64-slice multidetector row computed tomography) as part of a general health evaluation.


RESULTS
Atherosclerotic plaques were identified in 215 (22%, 2 +/- 1 segments/subject) individuals; 40 individuals (4%) had only noncalcified plaques. Fifty-two (5%) subjects had significant (>or=50%) diameter stenosis and 21 (2%) had severe (>or=75%) stenosis. Thirteen (25%) and 30 (58%) subjects with significant stenosis were classified into National Cholesterol Education Program low-risk and mild coronary calcification (coronary artery calcium scores <100), respectively. Midterm follow-up (17 +/- 2 months) revealed 15 cardiac events only in those with CAD on CTA: 1 unstable angina requiring hospital stay and 14 revascularization procedures. Most (87%) events occurred within 90 days of index CTA.


CONCLUSIONS
The prevalence of occult CAD in apparently healthy individuals was not negligible, although their midterm prognosis was good. CTA has a potential to provide a better insight about the occult CAD in this population. However, on the basis of our results and considering present radiation exposure data, we cannot recommend that CTA be used as a screening tool for this population at this point.
Choi
Eue-Keun
EK
Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
Choi
Sang Il
SI
Rivera
Juan J
JJ
Nasir
Khurram
K
Chang
Sung-A
SA
Chun
Eun Ju
EJ
Kim
Hyung-Kwan
HK
Choi
Dong-Joo
DJ
Blumenthal
Roger S
RS
Chang
Hyuk-Jae
HJ
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed