The role of atherosclerotic plaque imaging techniques in the primary prevention of cardiovascular disease remains to be determined. Perhaps the most promising technique at the moment is coronary CT, which has a high sensitivity for the detection of atherosclerosis. However, the benefits of CT must be balanced against the risks of contrast and radiation exposure. In this study, McEvoy et al. examined how the information gained from coronary CT influences the treatment and investigation of asymptomatic patients.
The authors studied 1000 patients drawn from a prior screening study at Seoul National University Bundang Hospital, all of whom had previously undergone 64-slice multidetector CT, and a further 1000 patients who had not undergone CT acted as a matched control group. 215 patients in the coronary CT group had a positive scan suggestive of coronary atherosclerosis, and these patients subsequently saw an increase in medication use compared to both those patients with a negative scan and the control group; in particular, aspirin and statin use were increased at both 90 days and 18 months. Furthermore, those patients with a positive coronary CT scan were subject to more secondary testing and invasive procedures than patients with a negative scan or in the control group. Noticeably, only one cardiovascular event occurred in each group over 18 months.
Patients with a positive coronary CT scan are more likely to receive aspirin and statin treatment than those with a negative scan, and are also subject to more secondary tests. However, randomised trials with longer follow-up are needed to assess whether the information gained from coronary CT can be used to alter outcomes.
- McEvoy JW, Blaha MJ, Nasir K et al. Impact of Coronary Computed Tomographic Angiography Results on Patient and Physician Behavior in a Low-Risk Population. Arch Intern Med 2011; Published online May 23, 2011. doi:10.1001/archinternmed.2011.204