Prevalence and clinical predictors of atherosclerotic coronary artery disease in asymptomatic patients undergoing coronary multidetector computed tomography

OBJECTIVE: We examined the prevalence and clinical predictors of atherosclerotic coronary artery disease in asymptomatic patients undergoing multidetector computed tomography BACKGROUND: In recent years multidetector computed tomography imaging has taken a leading role in the detection of subclinical atherosclerosis, even before its clinical manifestation. We examined the prevalence and clinical predictors of atherosclerotic coronary artery disease in asymptomatic patients undergoing multidetector computed tomography of the coronary arteries. METHODS: A total of 244 consecutive asymptomatic patients (190 men and 54 women aged 53.8+/-7.9 years) with at least one atherogenic risk factor underwent multidetector computed tomography angiography of the coronary arteries. The severity and extent of coronary atherosclerosis were graded and evaluated against clinical and laboratory parameters. RESULTS: Multidetector computed tomography identified significant obstructive coronary artery disease (>50% luminal stenosis) in 13 patients (4.9%), mild or moderate nonobstructive disease (<50% stenosis) in 124 patients (50.8%), and no atherosclerosis in 108 patients (44.3%). On multivariate logistic regression analysis, significant independent clinical predictors of coronary artery disease were male sex (odds ratio, 1.6, P<0.0047), family history of coronary artery disease (odds ratio, 1.4, P<0.0099), low-density lipoprotein cholesterol >130 mg/dl (OR 1.3, P<0.027), hypertension (odds ratio, 1.27, P<0.05), and noninsulin-dependent diabetes mellitus (odds ratio, 1.6, P<0.006). On the basis of the multidetector computed tomography results, pharmacological treatment was initiated or intensified in 40% of patients (statins in 31% and aspirin in 9%). Twenty-two patients (9%) were referred for complementary exercise testing and five (2%) for catheterization. CONCLUSIONS: (i) Occult atherosclerosis is not uncommon in asymptomatic patients with a risk profile for coronary artery disease. (ii) Conventional risk factors independently correlate with imaging findings of coronary atherosclerosis. (iii) Risk management could be intensified in a significant proportion (approximately 40%) of patients based on the multidetector computed tomography findings. (iv) In approximately 5% of patients at clinical risk, multidetector computed tomography might detect obstructive atherosclerosis that mandates further investigation.