Radiography Chest There is no relevant literature to support the use of chest radiographs alone as a test to evaluate asymptomatic patients at intermediate risk of CAD. Asymptomatic Patient at Risk for CAD plaque only seen on CTA. With a mean follow-up period of 2.65 years, MACE rate was 0% in CAD negative and higher (1.2%) in CAD positive by CTA. In a large multicenter registry of 27,125 patients (which included both symptomatic and asymptomatic patients), Min et al [45] found that CCTA improved discrimination by maximal stenosis, number of obstructive vessels, and segment stenosis score (C-index 0.77, 0.77, and 0.78, respectively) beyond age, gender, and CAC score (C-index 0.64) in a small subset of 400 asymptomatic patients. Similarly, CCTA findings improved risk reclassification by per patient maximal stenosis (integrated discrimination improvement [IDI] index, 0.03; P = . 03) and number of obstructive vessels (IDI index, 0.06; P = . 002), and by trend for segment stenosis score (IDI, 0.03; P = . 06). US Echocardiography Transthoracic Resting There is no relevant literature supporting the use of resting TTE in asymptomatic patients at high risk of CAD. US Echocardiography Transthoracic Stress TTE performed at rest and stress can assess for inducible wall-motion abnormalities, thus revealing ischemic heart disease. The sensitivity and specificity of the test is 72% to 83% and 84% to 95%, respectively, and has been validated only in symptomatic elevated risk populations and is best utilized to identify obstructive major epicardial coronary stenosis [20]. There is no relevant literature to support the use of stress TTE in asymptomatic patients at high risk of CAD. MRA Coronary Arteries MRA of the coronary arteries can assess for arterial patency and pathologic wall thickening but not calcific burden, and it cannot reliably assess small, distal vessels [35,36].
Asymptomatic Patient at Risk for Coronary Artery Disease PCAs. Radiography Chest There is no relevant literature to support the use of chest radiographs alone as a test to evaluate asymptomatic patients at intermediate risk of CAD. Asymptomatic Patient at Risk for CAD plaque only seen on CTA. With a mean follow-up period of 2.65 years, MACE rate was 0% in CAD negative and higher (1.2%) in CAD positive by CTA. In a large multicenter registry of 27,125 patients (which included both symptomatic and asymptomatic patients), Min et al [45] found that CCTA improved discrimination by maximal stenosis, number of obstructive vessels, and segment stenosis score (C-index 0.77, 0.77, and 0.78, respectively) beyond age, gender, and CAC score (C-index 0.64) in a small subset of 400 asymptomatic patients. Similarly, CCTA findings improved risk reclassification by per patient maximal stenosis (integrated discrimination improvement [IDI] index, 0.03; P = . 03) and number of obstructive vessels (IDI index, 0.06; P = . 002), and by trend for segment stenosis score (IDI, 0.03; P = . 06). US Echocardiography Transthoracic Resting There is no relevant literature supporting the use of resting TTE in asymptomatic patients at high risk of CAD. US Echocardiography Transthoracic Stress TTE performed at rest and stress can assess for inducible wall-motion abnormalities, thus revealing ischemic heart disease. The sensitivity and specificity of the test is 72% to 83% and 84% to 95%, respectively, and has been validated only in symptomatic elevated risk populations and is best utilized to identify obstructive major epicardial coronary stenosis [20]. There is no relevant literature to support the use of stress TTE in asymptomatic patients at high risk of CAD. MRA Coronary Arteries MRA of the coronary arteries can assess for arterial patency and pathologic wall thickening but not calcific burden, and it cannot reliably assess small, distal vessels [35,36].