Computed tomography coronary angiography in the selection of outlier patients: a feasibility report

Purpose This study evaluated criteria, presence and distribution of outlier patients by means of computed tomography coronary angiography (CTCA) in a large institutional database. Material and methods From a population of 2,881 consecutive patients (1,842 men, mean age 62±13 years) in sinus rhythm who underwent CTCA, we extracted data on patients with suspected coronary artery disease (CAD). We selected patient outliers in the fifth and sixth decades of life with the following criteria: ≥3 risk factors and absence of CAD, zero to one risk factors and ≥5 diseased coronary segments. Diabetes was excluded from risk factors because of the different impact on CAD. Results The patient population consisted of 2,432 individuals with suspected CAD (1,495 men, age 62±13 years). The prevalence of obstructive CAD (≥50% lumen reduction at CTCA) was 36% (863/2,432). Patients with normal coronary arteries accounted for 34% of the total (837/2,432; 431 men, age 55±14 years). Of these, 210 were in the fifth and 231 in the 6th decade (men 196, women 245); those with ≥3 risk factors accounted for 4.2% of the total (102/2,432; men 42, women 60). Patients with ≥5 diseased coronary segments accounted for 28% of the total (686/2,432; 510 men, age 68±10 years). Of these, 115 were in the fifth and 270 in the sixth decade (men 309, women 76); those with zero to one risk factors accounted for 3.0% (73/2,432; men 66, women 7). Conclusions CTCA is a reliable noninvasive diagnostic modality that can be used to identify outlier patients. This will enable dedicated trials aimed at characterising biomarkers and genomics of protective and nonprotective factors against CAD and its complications.