Role of noninvasive imaging in asymptomatic high-risk patients

Conclusions  CACS is highly predictive of major CVD events, independent of traditional risk factors including the FRS, body mass index, family history of premature CVD, and high-sensitivity C-reactive protein.36 A synthesis of available prognostic evidence reveals that patients with an intermediate FRS and a high-risk CAC score are at CVD risk-equivalent status with annual event rates of 2% or higher. This evidence is consistent with a multimarker approach for risk assessment that includes compounding novel and traditional risk factors to identify higher-risk subsets of patients. Another example of compounding risk is the combination of CT and SPECT markers. In those patients with high-risk subclinical disease, the frequency of inducible ischemia with SPECT is substantially increased. Nearly one quarter of patients with a high-risk CAC score will have ischemia on SPECT imaging. Thus it is anticipated that upcoming appropriateness criteria and guidelines may be more supportive of the use of CACS as a screening tool for risk assessment indications in asymptomatic individuals37,38 and that this evidence may translate into reimbursement for subclinical disease screening.39 It is hoped that strategies aimed at the detection of subclinical atherosclerosis may result in further reductions in CVD mortality rates, saving thousands of lives and reducing the economic burden of obstructive coronary disease.