CCTA identified coronary inflammation in 24.1% of patients, including 29.8% non-obstructive and 10.1% obstructive CAD even in those without standard risk factors.
What are the real-world clinical indications and imaging findings of CCTA in Greece?
Real-world registry data from Greece demonstrates that CCTA is predominantly used for screening asymptomatic individuals, frequently identifying non-obstructive CAD and coronary inflammation even in patients without standard modifiable risk factors.
Absolute Event Rate: 0% vs 0%
Abstract Background Coronary computed tomography angiography (CCTA) is highly recommended as a diagnostic method to exclude coronary artery disease (CAD) in patients with stable chest pain, while it is also increasingly used for asymptomatic individual screening. Beyond coronary anatomy visualization, CCTA may ameliorate cardiovascular risk stratification through detection of high-risk plaque features and the measurement of novel coronary inflammation metrics, such as the fat attenuation index (FAI). In this study, we explored the current clinical use of CCTA in Greece, as also the findings of atheromatosis and coronary inflammation in different subgroups. Methods CCTA data along with clinical history from 2,180 patients undergoing CCTA (65.1% male, mean age 57.8 years) were collected across five centers. In a nested analysis (n=357), CCTAs of patients without obstructive CAD were analysed using the CaRi-Heart® platform to detect coronary inflammation (defined as FAI-Score ≥90th percentile for LAD or RCA). Statistical analyses were performed using SPSS software version 25.0 (SPSS, Inc, Chicago, Illinois). Results Most patients referred for CCTA were asymptomatic (59.3%), while only 17.8% of patients presented with chest pain or angina equivalent (Figure, panel A). In the overall cohort, 37.2% had non-obstructive and 21.7% obstructive CAD. Among patients without standard modifiable risk factors for CAD (SMuRFs) 29.8% had non obstructive and 10.1% obstructive CAD (Figure, panels B-C). Also, among asymptomatic individuals the prevalence of CAD either non-obstructive or obstructive was high. In the nested coronary inflammation analysis, 24.1% of patients exhibited a high FAI-Score, with significant prevalence even among individuals without SMuRFs (Figure, panels D-E). Conclusions CCTA is predominantly used for screening asymptomatic individuals in Greece, highlighting its expanding role beyond symptomatic patient evaluation. A significant proportion of patients, including those without SMuRFs and asymptomatic individuals, exhibited coronary atheromatosis and inflammation. Notably, the presence of coronary inflammation (high FAI-Score) was prevalent in approximately one in four patients, even in the absence of obstructive CAD, underscoring the potential role of CCTA in early cardiovascular risk stratification. These findings emphasize the need for broader implementation of CCTA-based risk assessment tools to refine preventive strategies in diverse patient populations.Figure
Simantiris et al. (Sat,) reported a other. CCTA identified coronary inflammation in 24.1% of patients, including 29.8% non-obstructive and 10.1% obstructive CAD even in those without standard risk factors.