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CT coronary angiography in asymptomatic male patients with high atherosclerosis risk: Is it justified?
Adam Hatzidakis1, Eirini Savva2, Konstantinos Perisinakis3
1Department of Radiology, AHEPA University Hospital, Aristotle University, Medical School of Thessaloniki, Greece.
Insights
Computerized tomography coronary angiography (CTCA) effectively screens asymptomatic men over 50 with multiple risk factors for coronary artery disease (CAD). This screening identifies significant blockages, guiding necessary interventions for high-risk individuals.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of mortality in men.
- Early detection of significant coronary artery stenosis in asymptomatic individuals is crucial for timely intervention.
- Risk stratification in asymptomatic patients with multiple atherosclerosis risk factors requires effective screening tools.
Purpose of the Study:
- To evaluate the necessity and efficacy of computerized tomography coronary angiography (CTCA) for screening asymptomatic male patients.
- To determine the diagnostic performance of CTCA in identifying significant coronary artery stenoses in a high-risk population.
- To assess the clinical utility of CTCA in guiding management decisions for asymptomatic men with cardiovascular risk factors.
Main Methods:
- A prospective study included 226 asymptomatic males over 50 with at least three atherosclerosis risk factors.
- Participants had no prior history of significant cardiac events or contraindications for CTCA.
- Informed consent was obtained, detailing risks associated with contrast media and radiation.
Main Results:
- CTCA identified significant coronary artery stenoses in 23% (52/226) of asymptomatic male patients.
- Of those with stenosis, 38 underwent invasive coronography; 14 were lost to follow-up.
- CTCA demonstrated a sensitivity of 74.3% and specificity of 62% for significant stenosis. Patients with positive CTCA findings were more likely to have a family history of CAD (P < 0.05).
Conclusions:
- Computerized tomography coronary angiography (CTCA) is a valuable tool for screening asymptomatic male patients at high risk for coronary artery disease (CAD).
- CTCA can effectively identify significant coronary artery stenoses, aiding in the selection of patients who may benefit from further invasive evaluation or intervention.
- The screening is particularly useful in asymptomatic men with a positive family history of CAD or multiple established risk factors (>3).
Purpose:
To study the necessity of coronary artery screening with computerized tomography coronary angiography (CTCA) in asymptomatic male patients.
Material And Methods:
A total of 226 asymptomatic male patients aged over 50 years were included in this prospective study, according to a clinical protocol approved by the Heraklion University Hospital's Ethics Committee. All participants had at least 3 or more known atherosclerosis risk factors. All patients had none or normal noninvasive cardiological tests in the past and had no contraindications for CTCA. All patients gave their informed consent after being notified regarding contrast medium and radiation dose risks.
Results:
Significant stenoses were found in 52 asymptomatic males (23%). Out of them, 38 male patients underwent invasive coronography and 14 patients were lost in follow-up. In 18 patients, no lesions were found (47.4%). In the other 20 (52.6%) patients, 28 lesions were found. Stent placement was performed in 11 patients, bypass surgery was proposed in 3 patients, and in another 6 patients conservative treatment was suggested. Patients with findings in CTCA were more likely to have a family history of coronary artery disease, compared to patients with normal CTCA (P < 0.05 by using Fischer's Exact Test). Sensitivity of CTCA for significant stenosis was 74.3% with a specificity of 62%.
Conclusion:
CTCA may be used to screen for clinically significant coronary artery disease (CAD) in asymptomatic male patients, particularly those with positive family history or potentially high-risk patients with >3 risk factors for CAD.
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