[Prevention of coronary artery disease. Role of noninvasive imaging]

Area of Science:

• Cardiovascular Medicine
• Radiology
• Preventive Cardiology

Context:

• Atherosclerosis is a leading cause of death and disability, often asymptomatic until a critical event.
• Traditional risk scores categorize many individuals into an intermediate-risk group, necessitating refined assessment methods.
• Current diagnostic tools have limitations in identifying high-risk individuals for coronary artery disease.

Purpose:

• To evaluate the added prognostic value of coronary calcium determination in cardiovascular risk stratification.
• To explore the utility of myocardial perfusion scintigraphy in specific patient subgroups.
• To assess emerging plaque imaging techniques for clinical application.

Summary:

• Coronary calcium scoring provides independent prognostic information, with higher scores correlating to substantially increased cardiovascular event rates.
• The method is integrated into international guidelines due to its incremental risk prognostication capabilities.
• Combining coronary calcium scoring with myocardial perfusion scintigraphy offers cost-effective risk stratification for type 2 diabetes and very high-risk patients.

Impact:

• Enhances risk stratification for intermediate-risk populations, enabling more personalized preventive strategies.
• Supports clinical decision-making by providing objective data on subclinical atherosclerosis.
• Highlights the need for further research and validation of advanced imaging techniques like CT and MRI for broader clinical adoption.