Cardiovascular computed tomography for risk stratification of coronary artery disease

Multi-slice computed tomography coronary angiography (CTA) provides direct noninvasive anatomic assessment of the coronary arteries allowing for early identification of coronary artery disease (CAD). This information is useful for diagnosis of CAD, particularly the rule out of CAD. In addition, early identification of CAD with CTA may also be useful for risk stratification. The purpose of this review is to provide an overview of the current literature on the prognostic value of CTA and to discuss how the prognostic information obtained with CTA can be used to further integrate the technique into clinical practice. Non-invasive anatomic assessment of plaque burden, location, composition and remodeling using CTA may provide prognostically relevant information. This information has been shown to be incremental to the Framingham risk score, coronary artery calcium scoring and myocardial perfusion imaging. Characterization of atherosclerosis non-invasively has the potential to provide important prognostic information enabling a more patient tailored approach to disease management. Future studies assessing outcome after CTA based risk adjustments are needed to further understand the value of detailed non-invasive anatomic imaging. second line test for risk stratification as the anatomic information has been shown to provide incremental prognostic information to myocardial perfusion imaging alone. Non-invasive anatomic assessment of plaque burden, location, composition and remodeling using CTA may provide prognostically relevant information, incremental to not only the Framingham risk score, but also to other imaging approaches as coronary artery calcium scoring and myocardial perfusion imaging. Thus, non-invasive characterization of atherosclerosis has the potential to provide a more patient tailored approach to disease management. Future studies assessing outcome after CTA based risk adjustments are needed to further understand the value of detailed non-invasive anatomic imaging.

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