A new staging system for coronary artery disease uses imaging to measure plaque in the coronary arteries. Doctors hope it can help them identify people with a high risk of serious events like heart attack or stroke.
Coronary artery disease (CAD) happens when plaque builds up inside the arteries that supply blood to your heart. It’s the most common type of heart disease in the United States.
In CAD, the arteries become narrower as plaque accumulates. Due to this, blood flow is reduced, often leading to chest pain (angina).
CAD is also a common cause of heart attack and can lead to heart failure over time.
A new staging system for CAD has been proposed and is currently being tested. It divides CAD into stages based on the amount of plaque found in the coronary arteries. Here’s what you need to know about this CAD staging system.
Staging systems give healthcare professionals an idea of the extent and severity of a medical condition. This helps guide how a condition is managed while also informing outlook.
There has not been a staging system for CAD that can help healthcare professionals identify people who are most at risk of major adverse cardiovascular events (MACE) like heart attack and stroke or help manage their symptoms.
Currently, cardiovascular risk is determined by focusing on known risk factors, such as:
- age
- sex
- other medical conditions
- lifestyle habits
While these can all contribute to CAD, they’re not direct signs of disease.
Due to this, risk factor-based systems have flaws. For example, some people who have risk factors but little or no plaque accumulation may be overtreated. Conversely, people with significant plaque accumulation but few risk factors may not receive the treatment they need.
To address this issue, researchers have developed a potential staging system for CAD. This staging system is currently being tested in a clinical trial to see if it’s more effective at reducing MACE than risk factor-based systems.
In 2022, researchers proposed a staging system for CAD. This system is based on the amount of plaque measured in the coronary arteries using a type of imaging called coronary computed tomography angiography (CCTA).
Two parameters were used to determine the stages of CAD:
- Total plaque volume (TPV): This reflects the extent of the plaque. It’s reported in cubic millimeters (mm3).
- Percent atheroma volume (PAV): This is the percentage of the blood vessel wall that’s occupied by plaque.
Let’s look at each of the CAD stages:
Coronary artery disease stage 0
In stage 0, no plaque can be detected. Values for both TPV and PAV are 0.
Coronary artery disease stage 1
People with stage 1 CAD have mild levels of plaque. Stage 1 is defined as a TPV value of up to 250 mm3 or a PAV value of up to 5%.
People with stage 1 mostly have non-obstructive disease. While the blood vessels have detectable plaque buildup, blood flow to the heart isn’t yet impaired.
Coronary artery disease stage 2
Stage 2 CAD is characterized by moderate plaque levels. This stage is defined as a TPV value of between 250 and 750 mm3 or a PAV value of between 5% and 15%.
Coronary artery disease stage 3
Stage 3 is the highest stage of CAD, in which people have severe plaque volume. It’s defined as a TPV value greater than 750 mm3 or a PAV value over 15%.
People with stage 3 CAD typically have ischemic disease. This means that blood flow to the heart has become reduced due to coronary arteries that have become narrowed or blocked with plaque.
This new CAD staging system isn’t being used yet. Before it can be adopted more widely, clinical trials need to show that it’s similarly or more effective at preventing MACE than the current risk factor-based system.
The TRANSFORM trial is currently underway to evaluate this question. It started in 2024 and is expected to last 5 years (until 2029).
Preliminary data from 2023 found the new staging system did effectively classify people at risk for MACE. Compared to stage 0 and 1 combined, those with stage 2 and 3 CAD had three- and six-times the 10-year risk of MACE, respectively.
However, these results only used data from 328 people. To support the effectiveness of the new staging system, a larger group will need to be studied.
The researchers hope to recruit 7,500 people to participate in the TRANSFORM trial.
The new staging system uses a type of imaging scan called CCTA to estimate the levels of plaque in the coronary arteries.
CCTA uses X-rays to make many images of your heart and its associated blood vessels. A computer can then be used to combine these images to create a 3D image.
A healthcare professional can use the 3D images generated by CCTA to determine the levels of plaque in your coronary arteries and the amount of narrowing (stenosis) that it causes.
An advantage of CCTA is that it’s noninvasive. It only potentially involves an injection of a contrast dye to help a medical professional see narrowing or blockages in blood vessels. It’s also a short procedure, taking roughly
Having an effective staging system in place for CAD can help medical professionals better identify people who have a high risk of MACE in the future. In these people, treatment can be started early to prevent MACE.
While everyone can benefit from a CAD staging system, there’s especially one group that it would greatly aid: People with higher levels of plaque who may not have symptoms or many risk factors associated with CAD.
Under the current risk factor-based system, these people may not be receiving the preventive care they need. An effective staging system can help get them started on interventions that can reduce their risk of future complications.
If you’re concerned about your risk of CAD, contact a doctor to discuss it. They can go over your medical history, assess your risk factors, and order tests to determine your risk.
Medical emergency
Call emergency medical services or go to the nearest emergency room if you experience chest pain that’s persistent and doesn’t go away, as well as other symptoms of a heart attack, such as:
- discomfort or pain at other locations, such as the jaw, neck, arms, or stomach
- shortness of breath
- dizziness or lightheadedness
- a cold sweat
- nausea
Can you stop CAD from progressing?
Yes. While there’s no way to reverse CAD, treatment with medications and lifestyle changes can help slow or stop its progression.
What is the life expectancy of someone with coronary artery disease?
Some people with CAD go on to live long lives. However, CAD also increases your risk of having a heart attack.
Researchers have proposed a new staging system for coronary artery disease. It uses imaging to measure the levels of plaque in a person’s coronary arteries and classify them based on severity.
The new staging system isn’t currently in use, although preliminary data suggests that it’s effective at estimating the risk of major cardiovascular events. A larger clinical trial is currently underway to compare the new system to the current risk factor-based system.
In the meantime, if you have concerns about your risk of CAD, reach out to a healthcare professional. They can assess your level of risk and recommend preventive measures.
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