Key result
CCTA refines primary prevention risk stratification by identifying non-calcified and high-risk plaques.
Why the study?
Traditional probabilistic risk models do not directly identify individual coronary atherosclerosis, and CAC scoring is limited to calcified plaque. This review summarizes evidence on CCTA in primary prevention for detecting subclinical atherosclerosis, characterizing high-risk plaque, and improving cardiovascular risk stratification.
Does coronary computed tomography angiography (CCTA) improve cardiovascular risk stratification and detection of subclinical atherosclerosis compared to traditional probabilistic risk models and CAC scoring in primary prevention?
Does coronary computed tomography angiography (CCTA) improve cardiovascular risk stratification and detection of subclinical atherosclerosis compared to traditional probabilistic risk models and CAC scoring in primary prevention?
This review summarizes how coronary CT angiography complements traditional risk models and calcium scoring in primary prevention by identifying non-calcified and high-risk coronary plaques to guide personalized preventive therapy.
Answers are grounded in this paper and cite their sources.
CCTA may refine primary prevention stratification via plaque features; leaves open outcome benefits in prospective trials.
Cardiovascular risk stratification represents a cornerstone of cardiovascular prevention. Traditional probabilistic risk models, such as Systematic COronary Risk Evaluation 2 (SCORE2) and Systematic COronary Risk Evaluation 2-Older Persons (SCORE2-OP), provide population-based estimates of cardiovascular risk but do not allow direct identification of coronary atherosclerosis in the individual patient. This limitation is particularly relevant in individuals classified as being at intermediate risk, in whom the estimated probability of events may not accurately reflect the true atherosclerotic burden. Coronary imaging has progressively emerged as a complementary tool in cardiovascular risk assessment. Coronary artery calcium (CAC) scoring represents one of the strongest prognostic markers in asymptomatic populations; however, it provides information limited to the calcified component of atherosclerosis. Coronary computed tomography angiography (CCTA) allows a more comprehensive evaluation of coronary artery disease (CAD), enabling the identification of non-calcified plaques, quantification of total atherosclerotic burden, and characterization of plaque features associated with vulnerability. Recent evidence has demonstrated that the presence of non-obstructive CAD and high-risk plaque features on CCTA is associated with a significantly increased risk of cardiovascular events, regardless of the degree of luminal stenosis. Furthermore, serial CCTA imaging allows monitoring of disease progression and assessment of the response to lipid-lowering treatment. The aim of this review is to summarize current evidence regarding the role of CCTA in primary prevention, focusing on its contribution to detection of subclinical atherosclerosis, identification of high-risk plaque features, cardiovascular risk stratification, and future perspectives for personalized preventive strategies.
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Michele et al. (2026) conducted a review in Subclinical coronary atherosclerosis / cardiovascular risk stratification in primary prevention. Coronary computed tomography angiography (CCTA) vs. Traditional probabilistic risk models (SCORE2, SCORE2-OP) and coronary artery calcium (CAC) scoring was evaluated on Detection of subclinical atherosclerosis, identification of high-risk plaque features, and cardiovascular risk stratification. Coronary computed tomography angiography (CCTA) enables identification of non-calcified plaques, total atherosclerotic burden, and high-risk plaque features to improve primary prevention risk stratification.
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