Incidental Coronary Artery Disease on Routine CT Coronary Angiography –An evidence-based approach

Abstract

Listen

Translate article

Atherosclerotic coronary artery disease is the leading cause of high morbidity and mortality across the globe [1]. Coronary CT angiography has emerged as a highly accurate non-invasive diagnostic modality for the diagnosis of atherosclerotic coronary artery disease [2]. Coronary CT angiography should be considered as an alternative to stress imaging technique for ruling out atherosclerotic coronary artery disease in patients with the lower range of intermediate pre-test probability for atherosclerotic stable coronary artery disease. However, coronary CT angiography is not recommended as a screening test in asymptomatic individuals without clinical suspicion of coronary artery disease. CT Coronary angiography has been performed routinely before many of the cardiac and non-cardiac procedures like TAVI, atrial fibrillation ablation prior to the organ transplantation. Many a times, advised by Family Physician or patients themselves for a routine screening for atherosclerotic coronary artery disease undergo CT coronary angiography. When incidental atherosclerotic coronary artery disease is found in such patients who do not have any typical or atypical symptom suggestive of coronary artery disease then question arises how to approach this patient as far as the risk estimation for future adverse cardiovascular event and prognostication is concerned. It also becomes imperative to decide the line of management for this patient. To answer these two pertinent questions, we need to understand the behavior and natural history of atherosclerosis & performance of CT coronary angiography in diagnosis and in predicting the prognosis of atherosclerotic disease.