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Updated: Sep 20, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Multi-Modality Imaging for Prevention of Coronary Artery Disease and Myocardial Infarction in the General Population:
Daan Ties1, Paulien van Dorp1, Gabija Pundziute1
1University Medical Center Groningen, Thorax Centre, Faculty of Medicine, University of Groningen, 9713 GZ Groningen, The Netherlands.
Insights
Improved strategies are needed to prevent acute myocardial infarction (AMI) and sudden cardiac death (SCD). Early detection of advanced coronary artery disease (CAD) beyond current risk scores offers a promising approach for personalized prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Cardiovascular disease (CVD) is a leading global cause of mortality.
- Acute myocardial infarction (AMI) and sudden cardiac death (SCD) significantly contribute to CVD burden.
- Current prevention relies on risk assessment tools like clinical risk prediction scores (CRPSs) and coronary artery calcium scores (CACS).
Purpose of the Study:
- To review evidence for advanced testing beyond CRPSs and CACS for improved AMI and SCD prevention.
- To explore novel therapeutic targets for preventing adverse cardiovascular events.
- To evaluate the role of multi-modality imaging in clinical trials for asymptomatic individuals.
Main Methods:
- Review of existing evidence on advanced diagnostic strategies for coronary artery disease (CAD).
- Analysis of therapeutic targets including subclinical obstructive CAD and high-risk plaques.
- Evaluation of multi-modality imaging techniques for clinical trial enhancement.
Main Results:
- Current risk assessment may underestimate risk in some populations.
- Early detection of advanced CAD, high-risk plaques, and silent ischemia shows promise.
- Multi-modality imaging can support robust clinical trials.
Conclusions:
- Further testing beyond CRPSs and CACS is crucial for personalized AMI and SCD prevention.
- Targeting subclinical disease and high-risk plaques can improve outcomes.
- Enhanced prevention strategies are needed for individuals deemed "low-risk" by current standards.
Abstract:
Cardiovascular disease (CVD) remains a leading cause of death and disability worldwide. Acute myocardial infarction (AMI) causes irreversible myocardial damage, heart failure, life-threatening arrythmias and sudden cardiac death (SCD), and is a main driver of CVD mortality and morbidity. To control the forecasted increase in CVD burden for both the individual and society, improved strategies for the prevention of AMI and SCD are required. Current prevention of AMI and SCD is directed towards risk-modifying interventions, guided by risk assessment using clinical risk prediction scores (CRPSs) and the coronary artery calcium score (CACS). Early detection of more advanced coronary artery disease (CAD), beyond risk assessment by CRPSs or CACS, is a promising strategy to allow personalized treatment for the improved prevention of AMI and SCD in the general population. We review evidence for further testing, beyond CRPSs and CACS, and therapies focusing on promising targets, including subclinical obstructive CAD, high-risk plaques, and silent myocardial ischemia. We also evaluate the potential of multi-modality imaging to enhance the conduction of adequately powered trials to provide high-quality evidence on the impact of add-on tests and therapies in the prevention of AMI and SCD in asymptomatic individuals. To conclude, we discuss the occurrence of AMI and SCD in individuals currently estimated to be at "low-risk" by the current strategy based on CRPSs, and methods to improve prevention of AMI and SCD in this "low-risk" population.
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