Extract

This editorial refers to ‘Association between perivascular inflammation and downstream myocardial perfusion in patients with suspected coronary artery disease’, by C.H. Nomura et al., pp. 599–605.

Coronary computed tomography angiography (CTA) allows accurate rule-out of obstructive coronary artery disease (CAD) over a wide range of pre-test probabilities.1 Nevertheless, the majority of plaque rupture events associated with acute myocardial infarction arise from non-obstructive coronary plaques.2 Therefore, there has been a shift of interest from focus on luminal stenosis, and consequent downstream myocardial ischaemia, to detection and quantification of global atherosclerotic plaque burden, as well as plaque characterization for the presence of high-risk features. These measures identified by cardiac computed tomography were associated with increased rates of adverse events in recent posthoc analyses of two large randomized trials.3–5 Inflammation plays an important role in the progression of coronary atherosclerosis and its complications. Recent studies have provided evidence that a surrogate of coronary inflammation can be quantified by cardiac computed tomography.6,7

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