Coronary CT angiography in individuals suspected of having coronary disease without modifiable risk factors: is CT the key prognostic tool?

In a recent paper published in Radiology last June, Leipsic et al. [ 1] reported an interesting international multicenter study on the prognosis of patients suspected of having coronary artery disease (CAD) despite the absence of medically modifiable cardiovascular risk factors (e.g. smoking, hypercholesterolemia, diabetes or hypertension). From a large cohort of 27 125 patients undergoing CT angiography, 5262 persons with suspected (not already known) coronary disease but without modifiable risk factors were selected, diagnosed and followed for a mean of 2.3 years. In this population, which included symptomatic and asymptomatic patients (most asymptomatic patients had a family history of CAD), CAD was diagnosed in 2081 cases (39%) overall. About two-thirds of them (1452 patients; 27%) had nonobstructive disease while the others (629; 12%) had obstructive CAD (defined by at least one vessel with ≥50% stenosis). In the follow-up period, a major adverse cardiovascular event (MACE) occurred in 106 patients. The authors reported that patients with obstructive disease had a nearly 7-fold higher risk of MACE than patients with nonobstructive disease.