A prospective Danish cohort study revealed that subclinical obstructive coronary atherosclerosis is associated with a more than 8-fold elevated risk for myocardial infarction (MI). The study included 9533 asymptomatic persons aged 40 years or older without known ischemic heart disease. Coronary atherosclerosis was assessed with coronary computed tomography angiography and characterized according to luminal obstruction (≥50% luminal stenosis or not) and extent (≥1/3 of the coronary tree or not). A total of 54% had no subclinical coronary atherosclerosis, 36% had nonobstructive disease, and 10% had obstructive disease. In a median follow-up of 3.5 years (range, 0.1 to 8.9 years), 193 patients died and 71 had MI. The MI risk was increased in patients with obstructive (adjusted relative risk, 9.19) and extensive (7.65) disease. The highest MI risk was noted in patients with obstructive-extensive subclinical coronary atherosclerosis (adjusted relative risk, 12.48) or obstructive-nonextensive (adjusted relative risk, 8.28). This contrasts with symptomatic populations where nonobstructive disease accounts for most future MI, presumably from plaque rupture. The risk for the composite of death or MI was increased in patients with extensive coronary atherosclerosis, regardless of degree of obstruction. The study provides a benchmark about event rates and prevalence of asymptomatic coronary artery disease and indicates that screening for patients with obstructive and/or extensive subclinical coronary atherosclerosis could benefit from primary prevention intervention. Source: https://www.acpjournals.org/
