Abstract Objectives Individuals with normal coronary arteries may develop coronary artery disease (CAD). Coronary computed tomography (CT) angiography (CCTA) offers a non-invasive method to assess the development of CAD. Materials and methods In a post-hoc observational study of the Scottish Computed Tomography of the HEART (SCOT-HEART) trial, we identified patients with normal coronary arteries on initial CCTA who subsequently underwent clinically indicated CT. Images were visually assessed for the presence, severity, and type of CAD. Results Normal coronary arteries on baseline CCTA were present in 524 patients (mean age 53 ± 10 years, 38% male). After a median of 9.3 (Interquartile range, IQR: 9.3–10.8) years, 31 (6%) underwent repeat CCTA and 162 (31%) underwent chest CT. There were no differences in baseline clinical characteristics amongst those who did or did not have repeat CCTA, but those with subsequent chest CT were older and had higher cardiovascular risk scores. CAD was identified on 48% ( n = 15) of CCTA and 25% ( n = 41) of chest CT. Median time to CT scan on which CAD was identified was 8.1 (IQR: 6.9–9.7) years. There was no difference in all-cause mortality or combined CAD death or non-fatal myocardial infarction in patients who had CAD identified on subsequent CT. However, they were more likely to undergo invasive coronary angiography (adjusted hazard ratio aHR 4.94, 95% confidence interval CI: 1.95, 12.51; p < 0.001) and revascularization (aHR 19.99, 95% CI: 1.69, 237.1; p = 0.018), adjusted for age and sex. Conclusion One third of patients with previously normal CCTA will develop CAD on clinically indicated CT imaging over a 10-year period. Key Points Question In patients with normal coronary arteries on coronary computed tomography angiography (CCTA), the risk of developing CAD in the future is uncertain . Findings Among 524 patients with normal coronaries, CAD was identified on 48% of CCTA and 25% of chest CT during 10 years of follow-up . Clinical relevance A substantial proportion of patients with initially normal coronary arteries on CCTA later develop CAD, highlighting the need for clinicians to be alert for the development of new CAD in patients with initially normal coronary arteries . Graphical Abstract
Avigdor et al. (Wed,) studied this question.