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CLINICAL RESEARCH: CARDIAC IMAGING

Coronary Computed Tomography Angiography as a Screening Tool for the Detection of Occult Coronary Artery Disease in Asymptomatic Individuals

Eue-Keun Choi, MD^_*, Sang Il Choi, MD, Juan J. Rivera, MD, Khurram Nasir, MD, Sung-A. Chang, MD^_*, Eun Ju Chun, MD, Hyung-Kwan Kim, MD^_*, Dong-Joo Choi, MD^_*, Roger S. Blumenthal, MD and Hyuk-Jae Chang, MD, PhD^_*,_*

^_* Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
Division of Radiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Massachusetts General Hospital Cardiac MRI, PET, CT Program, Boston, Massachusetts.

Manuscript received October 29, 2007; revised manuscript received January 16, 2008, accepted February 13, 2008.

^_* Reprint requests and correspondence: Dr. Hyuk-Jae Chang, Cardiovascular Center, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-802, Republic of Korea. (Email: hjchang{at}snu.ac.kr).

Objectives: 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 (50%) diameter stenosis and 21 (2%) had severe (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. (Subclinical COronary Atheroscleorosis Updated With Coronary cT Angiography [SCOUT Study]; NCT00431860)

Key Words: arteriosclerosis • coronary angiography • coronary tomography • mass screening • X-ray computed

Abbreviations and Acronyms   CAC = coronary artery calcium   CACS = coronary artery calcium score(s)   CAD = coronary artery disease   CAG = coronary angiography   CHD = coronary heart disease   CTA = computed tomography angiography   LAD = left anterior descending artery   MDCT = multidetector row computed tomography   NCEP = National Cholesterol Education Program   PCI = percutaneous coronary intervention

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