These benefits were largely attributable to subsequent changes in patient management and treatment, which had been guided by the presence of obstructive or nonobstructive coronary artery disease as determined by coronary CTA.
However, it may be that further risk stratification and targeted intensification of therapy in patients with adverse plaque characteristics could achieve additional benefits that go beyond the presence of obstructive or nonobstructive coronary artery disease.
CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed.
This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. As it grows, less blood can flow through the arteries.
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This cookie stores just a session ID; no other information is captured.Accepting the NEJM cookie is necessary to use the website.Methods In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years.The SCOT-HEART trial was a multicenter randomized controlled trial of coronary CTA in outpatients with suspected angina pectoris due to coronary artery disease (9).The primary results have been reported previously (6–8).Recent data have suggested that positive remodeling and low attenuation plaque in particular provide the most useful prognostic information (2,5), although it remains unclear whether this is of incremental value to traditional cardiovascular risk factors or coronary plaque burden.In the SCOT-HEART (Scottish COmputed Tomography of the HEART) prospective, multicenter, randomized controlled trial of patients with stable chest pain, the addition of coronary CTA to routine care led to improved diagnostic certainty and patient care that ultimately reduced the rate of coronary heart disease death or nonfatal myocardial infarction (6–8).Results Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features.Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs.Myocardial-perfusion cardiovascular MRI is noninferior to invasive angiography and fractional flow reserve for guiding coronary revascularization in patients with stable angina and risk factors for coronary artery disease. uses cookies to improve performance by remembering your session ID when you navigate from page to page.
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