[Prevention of coronary artery disease. Role of noninvasive imaging]

Abstract

Atherosclerosis and its complications are currently the most deadly and disabling diseases in affluent countries. Many individuals, even those with severe atherosclerosis, are unaware of their risk, because they have no symptoms. In 30-50% of patients, an acute heart attack is the first indicator of atherosclerosis. Risk stratification based on traditional risk factors (e.g., Framingham, PROCAM, ESC Scores) may identify persons at low and very high risk of heart attack or stroke within the next 10 years, but the majority of the population belongs to an intermediate-risk group. In this subgroup of individuals, the determination of coronary calcium adds independent prognostic information. With higher calcium scores the cardiovascular event rates increased substantially (five- to tenfold). The fact that coronary calcium affords incremental risk prognostication has led to the implementation of this method in international guidelines. The combination with myocardial perfusion scintigraphy also allows a cost-effective risk stratification in uncomplicated type 2 diabetes and in subjects with very high calcium scores (> 1,000). Plaque imaging with contrast-enhanced multislice spiral computed tomography is promising but is still not incorporated in the daily clinical routine. At present, magnetic resonance imaging is a promising research tool but is not yet appropriate in identifying subjects with high risk for coronary artery disease.