Aller à la navigation principale
Skip notifications
À compter du 1er décembre 2023, l’accès à POEMs et à Essential Evidence Plus ne fera plus partie des avantages offerts aux membres de l’AMC.
Search
Asymptomatic atherosclerosis found on CTA is associated with increased risk of myocardial infarction
Question clinique
How common is asymptomatic coronary atherosclerosis, and what is the subsequent risk of myocardial infarction?
L’Essentiel
By an average age of 60 years, screening of asymptomatic people using coronary CTA will identify atherosclerosis in approximately 60% of men and 36% of women. A small proportion will have coronary artery partial obstruction. This group, as well as people with extensive atherosclerosis, regardless of level of obstruction, is at higher, but still low, risk of myocardial infarction (MI) over the next few years. This study was not designed to compare the benefit of screening with no screening, and we need more information before we start screening people for atherosclerosis. 1b
Référence
Plan de l'etude: Cohort (prospective)
Financement: Foundation
Cadre: Population-based
Sommaire
These researchers in Copenhagen invited asymptomatic persons in the general population, 40 years or older without known ischemic heart disease, to be screened for atherosclerosis via coronary computed tomography angiography (CTA). A total of 9533 patients were screened: most were White, 43% were men, and they had an average age of 60 years. Current smokers made up 11% of the group. Some level of coronary atherosclerosis was identified in 61% of men and 36% of women, and 10% of participants had a level of atherosclerosis deemed to be obstructive. Over a median follow-up of 3.5 years, 193 participants died due to any cause (2%) and 71 (0.7%) had a myocardial infarction (MI). The risk of MI was higher in patients with obstructive atherosclerosis (adjusted relative risk [ARR] 8.29 - 12.48) and the composite outcome of death or MI was higher in people with extensive atherosclerosis (ARR 2.70), independent of the degree of obstruction.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Impact assessment
Excellent
Screening?
Do we need a trial to compare the benefit of CTA screening with no CTA screening? Or should we just continue with CVD risk assessment using the Framingham (or other) validated risk calculator?
Well, there’s a sensible…
Well, there’s a sensible study.
Instead of assessing the risk of coronary disease using cholesterol screening and condemning people to a lifetime of medication and copious blood work, just find out if they have coronary disease and treat them if they do. …If they don’t by age 60 they’re unlikely to develop it.
ASYMTOMATIC ATHEROSCLEROSIS FOUND ON CTA
NEWS TO ME