Key result
Cardiac computed tomography identified occult coronary artery disease in 18.9% (95% CI 14.9-23.5%) of asymptomatic sportsmen aged ≥45 years after a normal sports medical evaluation.
Why the study?
Does cardiac computed tomography detect occult coronary artery disease in asymptomatic middle-aged sportsmen with a normal standard sports medical evaluation?
Cross-Sectional (n=318)
Does cardiac computed tomography detect occult coronary artery disease in asymptomatic middle-aged sportsmen with a normal standard sports medical evaluation?
Coronary CT, primarily through calcium scoring, detects occult coronary artery disease in nearly 20% of asymptomatic middle-aged sportsmen who have a normal standard sports medical evaluation.
May prompt targeted CCT consideration in older athletes despite normal evaluations; leaves open effects on outcomes and screening guidelines.
BACKGROUND: Most exercise-related cardiac arrests in men aged ≥45 years are due to coronary artery disease (CAD). The current sports medical evaluation (SME) of middle-aged sportsmen includes medical history, physical examination and resting and exercise electrocardiography (ECG). We investigated the added value of low-dose cardiac computed tomography (CCT) - both non-contrast CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography (CCTA) - in order to detect occult CAD in asymptomatic recreational sportsmen aged ≥45 years without known cardiovascular disease. METHODS: Following a normal SME (with resting and bicycle exercise ECG), 318 asymptomatic sportsmen underwent CCT and 300 (94%) had a low European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE) risk. Occult CAD was defined as a CACS ≥100 Agatston units (AU) or obstructive (≥50%) luminal stenosis on CCTA. The number needed to screen (NNS) in order to prevent one cardiovascular event within 5 years with statin treatment was estimated. RESULTS: Fifty-two (16.4%, 95% confidence interval (CI): 12.7-20.8%) of 318 participants had a CACS ≥100 AU. The CCTA identified an additional eight participants with luminal narrowing ≥50% (and a CACS <100 AU). Taken together, CCT identified CAD in 60 (18.9%, 95% CI: 14.9-23.5%) of 318 participants. The 5-year estimated NNS was 183 (95% CI: 144-236) for CACS and 159 (95% CI: 128-201) for CACS combined with CCTA. CONCLUSIONS: Coronary CT detects occult CAD in almost one in five asymptomatic sportsmen aged ≥45 years after a normal SME that included resting and bicycle exercise ECG. CACS reveals most of the relevant CAD with limited additional value of contrast-enhanced CCTA. The NNS in order to prevent one cardiovascular event compares favourably to that of other screening tests.
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Braber et al. (2016) conducted a cross-sectional in Occult coronary artery disease (n=318). Cardiac computed tomography (CCT) was evaluated on Occult CAD (CACS ≥100 AU or obstructive ≥50% luminal stenosis on CCTA) (95% CI 14.9-23.5). Cardiac computed tomography identified occult coronary artery disease in 18.9% (95% CI 14.9-23.5%) of asymptomatic sportsmen aged ≥45 years after a normal sports medical evaluation.
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