Screening Coronary CT Angiograms Find Treatable Heart Disease in 83% of Patients.
Even with a calcium score of zero, most patients had hidden, high-risk plaque detected by CCTA.
High-Risk Plaque on Cardiac CT Predicts Heart Attack Risk — Even Without Blocked Arteries
Article: "Association of High-Risk CT Coronary Artery Plaque Features with Major Adverse Cardiovascular Events: A Prespecified Secondary Analysis of the DISCHARGE Trial" (Szilveszter, Biavati, Sørum et al. — European Radiology, 2026)
A major study published in European Radiology analyzing data from the DISCHARGE trial — a prospective, randomized, 26-center European study of 1,745 stable chest pain patients — found that high-risk plaque (HRP) features detected on coronary CT angiography (CCTA) were independently associated with major adverse cardiovascular events (MACE), including heart attack, stroke, and cardiovascular death. Critically, patients who had high-risk plaque features without obstructive coronary artery disease faced nearly the same elevated risk as those with obstructive disease alone — approximately a 3.8-fold increased risk of MACE compared to patients with neither finding. Patients with both high-risk plaque and obstructive disease had the highest risk of all. High-risk plaque was defined by features including low-attenuation plaque, positive remodeling, the napkin-ring sign, or a coronary artery calcium score of 400 or greater.
These findings carry important implications for cardiovascular risk stratification and heart disease prevention. Traditional approaches have focused primarily on detecting whether arteries are significantly narrowed, but this research reinforces that plaque character matters just as much as plaque severity. Identifying high-risk plaque features on CCTA — even in patients without flow-limiting stenosis — can prompt earlier initiation of aggressive preventive therapies such as high-dose statins and risk factor modification before a heart attack occurs. If you have stable chest pain or known cardiovascular risk factors, a comprehensive coronary CT angiogram may provide critical information beyond what standard testing reveals. We invite you to speak with our team about whether advanced cardiac imaging is appropriate for you.
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