Assessing Risk and Predicting Outcomes in Coronary Artery Disease: Physiology, Anatomy, or Biology?

Abstract

Cardiovascular imaging has been able to demonstrate its importance identifying subjects at risk for future cardiac events. There is extensive evidence demonstrating that anatomic, physiologic, and biologic data can successfully risk stratify patients. A plethora of biomarkers predictive of patients’ risk have been identified. Although cardiovascular imaging modalities are capable of patient risk stratification, whether they are cost effective over clinical, historical, and biochemical data is uncertain. The incremental value provided by stress positron emission tomography and single photon emission CT has been extensively demonstrated. In addition, an increasing body of evidence supports the concept that coronary CT angiography is also able to stratify patients in regard to their risk of future cardiovascular events. The availability of hybrid myocardial perfusion imaging/CT technology permits simultaneous acquisition of anatomic, functional, structural information, and the potential for use of molecular techniques. The future application of these modalities will require extending the risk stratification paradigm to the identification of optimal patient management.