title: Coronary computed tomography angiography-based coronary risk stratification in subjects presenting with no or atypical symptoms.
abstract: BACKGROUND
  Coronary computed tomography angiography (CTA) findings of positive vessel remodeling and low-attenuation plaque, referred to as computed tomography-verified high-risk plaque (CT-HRP), have been reported to be associated with the development of subsequent acute coronary syndromes. The aim of this study was to examine the usefulness of coronary CTA for coronary risk re-stratification of patients with asymptomatic and atypical chest symptoms.
  
  
  RESULTS
  A total of 1,139 subjects (M/F 602/537; mean age, 61.5±9.3 years) who were either asymptomatic or presented with atypical chest symptoms underwent coronary 64- or 320-slice multidetector computed tomography angiography and Agatston score. Age, sex, coronary risk factors, including hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were investigated as predictors for CT-HRP on multivariate analysis using logistic regression analysis. CT-HRP was observed in 72 patients (6.3%). Based on Framingham risk scores (FRS), CT-HRP was observed in 0/94 subjects (0.0%) in the low-risk group, 35/806 (4.3%) in the intermediate-risk group, and 37/239 (15.5%) in the high-risk group. On logistic regression analysis significant predictors for CT-HRP in intermediate- and high-risk subjects were male sex (odds ratio [OR] 2.829; 95% confidence interval [CI] 1.460-5.479, P=0.0021), DM (OR 2.418; 95% CI 1.420-4.116, P=0.0011), and current smoking (OR 1.922; 95% CI 1.096-3.371, P=0.0160). CT-HRP prevalence for Agatston scores >500 and >250 was lower in the intermediate- and high-risk groups, respectively.
  
  
  CONCLUSIONS
  In asymptomatic subjects and those presenting with atypical chest pain who have a more than an intermediate risk, coronary CTA is contributory to FRS. Male sex, DM and smoking were independent predictors of vulnerable plaque in the more than intermediate-risk group.
authors.affiliation: Department of Cardiology, Takase Clinic, 885-2 Minami-orui, Takasaki 370-0036, Japan. s-fujimo@tj8.so-net.ne.jp
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.forename: Takahide
authors.initials: T
authors.lastname: Kodama
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Orihara
authors.forename: Junichi
authors.initials: J
authors.lastname: Sugiyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Kondo
authors.forename: Akira
authors.initials: A
authors.lastname: Endo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukazawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Nagaoka
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Oida
authors.forename: Takanori
authors.initials: T
authors.lastname: Ikeda
authors.forename: Junichi
authors.initials: J
authors.lastname: Yamazaki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takase
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000328:Adult; D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging; D050171:Dyslipidemias / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D012306:Risk; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed