What is the role of imaging in stratifying risk for coronary artery disease?

Updated: Mar 30, 2020
  • Author: F Brian Boudi, MD, FACP; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Studies indicate that using electron-beam computed tomography (EBCT) scanning to identify coronary calcification can reveal at-risk individuals and perhaps allow for medical monitoring. [7] With the advent of new 64-slice CT angiography, bulky plaques may be identified in asymptomatic patients.

The risk benefit of using CT angiography in an asymptomatic patient for the identification of atherosclerotic plaques is still a subject of much debate. The negative predictive value of CT angiography, however, is very high. CAD identified by CT angiography has significant prognostic implications. [65]

Carotid intima-media thickness (IMT), pulse wave velocity (PWV), and the ankle-brachial index (ABI) are widely used noninvasive modalities for evaluating atherosclerosis. [66]

Polak et al suggest the maximum intima-media thickness of the internal carotid artery along with the presence of plaque significantly but modestly improves the classification of risk of cardiovascular disease in the Framingham Offspring Study cohort. [67]

One study suggested regression or slow progression of carotid IMT due to cardiovascular drug therapies does not reduce cardiovascular events. [68]

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