title: Special Operations Soldier With Cardiac Family History: Use of CCTA and Protein Biomarker Testing to Detect Risk of Heart Attack From Noncalcified Plaque.
abstract: OBJECTIVE
  We sought to characterize the risk of a heart attack in a 48-year-old asymptomatic US Special Operations Command (SOCOM) Soldier without known coronary artery disease (CAD).
  
  
  BACKGROUND
  CAD continues to be a leading cause of morbidity and mortality among most age groups in the United States. Much research is dedicated to establishing new techniques to predict myocardial infarction (MI).
  
  
  METHODS
  Coronary computed tomography (CT) angiography, also known as CCTA, along with 7-protein serum biomarker risk assessment was performed for risk evaluation.
  
  
  RESULTS
  A 48-year-old SOCOM Soldier with a family history of heart disease had skeletal chest pain from war injuries and a 5-fold higher risk of heart attack over the next 5 years on the basis of protein markers. A nonobstructive left anterior descending coronary artery (LAD) plaque with a lipid-rich core and a thin fibrous cap (i.e., vulnerable plaque) was detected by CCTA. The patient was warned about his risk and prescribed four cardiac medications and scheduled for angioplasty even though he fell outside the guidelines by not having a severe obstructive blockage. Four days later, unfortunately, he had a heart attack before starting his medications and before angioplasty.
  
  
  CONCLUSIONS
  CCTA with biomarker testing may have an important role in predicating acute coronary syndrome (ACS) in Special Operations Forces (SOF) Soldiers with at least one risk factor. Conventional stress testing and nuclear scanning would not detect non-flow-limiting vulnerable plaques in vulnerable patients. In order to collect more data, the PROTECT Registry has been started to evaluate asymptomatic Soldiers with at least one risk factor referred to the clinic by military physicians.
authors.forename: Millee
authors.initials: M
authors.lastname: Singh
authors.forename: Anne
authors.initials: A
authors.lastname: Kroman
authors.forename: Juile
authors.initials: J
authors.lastname: Singh
authors.forename: Hassan
authors.initials: H
authors.lastname: Tariq
authors.forename: Shetal
authors.initials: S
authors.lastname: Amin
authors.forename: Cesar Alberto
authors.initials: CA
authors.lastname: Morales-Pablon
authors.forename: Kristina Vanessa
authors.initials: KV
authors.lastname: Cahill
authors.forename: Eric Edward
authors.initials: EE
authors.lastname: Harrison
mesh_terms: D015415:Biomarkers / Q000097:blood*; D001798:Blood Proteins / Q000032:analysis; D002637:Chest Pain / Q000097:blood; D017023:Coronary Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000000981:diagnostic imaging; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D001798:Blood Proteins