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High-risk coronary atherosclerosis at CCTA among patients with Family histoRy of coronary Artery disease: An InTERnational Multicentric Study (The FRATER Study)
Session:
Prémio Jovem Investigador
Speaker:
Pedro M. Lopes
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Sessão de Prémios
FP Number:
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Authors:
Rita Almeida Carvalho; Pedro Lopes; Kamil Stankowski; Edoardo Conte; Giuseppe Ciliberti; Daniele Andreini; Francisco Gama; Cláudia Silva; Sara Guerreiro; João Abecasis; Pedro Freitas; António Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Family history (FH) of coronary artery disease (CAD) is a well-recognized, non-modifiable cardiovascular risk factor. Although FH is included in standard clinical risk assessment, the prevalence and distribution of coronary atherosclerosis in this population have not been clearly defined. Coronary computed tomography angiography (CCTA) enables comprehensive non-invasive characterization of plaque burden, composition, and high-risk plaque (HRP) features. This study evaluated coronary atherosclerosis prevalence and features on CCTA in patients with and without FH of CAD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">This international, multicenter, observational study included consecutive patients who underwent clinically indicated CCTA between September 2022-September 2023 across 3 European centers. Patients with FH of CAD were matched 1:2 for age, sex, and traditional cardiovascular risk factors with controls without FH. Clinical pre-test likelihood of obstructive CAD was estimated using the Risk Factor–weighted Clinical Likelihood model. All CCTAs were analyzed in a centralized core laboratory by experienced readers using validated software for semi-automatic quantification of total, non-calcified (NCP; <350HU), and low-attenuation (LAP; <30HU) plaque volumes. HRP features included positive remodeling, napkin-ring sign, spotty calcifications, and LAP. Obstructive CAD was defined as ≥70% luminal area reduction in any coronary segment. High-risk atherosclerosis was defined as ≥2 HRP features and/or increased LAP (>10mm<sup>3</sup>) or NCP (>80mm<sup>3</sup>) volume.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">A total of 480 patients were included (160 with and 320 without FH of CAD), with a mean age of 61.7±9.6 years and 41.9% female. Clinical characteristics were comparable between groups. Patients with FH showed a higher prevalence of obstructive CAD (26% vs 18%, p=0.042), LAP (35% vs 19%, p<0.001), positive remodeling (61% vs 47%, p=0.003), and ≥2 HRP features (48% vs 32%, p<0.001). Total, NCP and LAP volumes were all significantly higher in the FH group (all p<0.05). Overall, high-risk atherosclerosis was more prevalent among those with FH (62% vs 43%, p<0.001). After multivariate adjustment for major risk factors, FH remained independently associated with high-risk atherosclerosis (OR 3.01, 95%CI 1.89–4.78, p<0.001). Among patients clinically classified as very low risk, high-risk atherosclerosis or obstructive CAD on CCTA were present in 42% of those with FH compared to 19% without FH (p<0.001) - Figure 1.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">This international multicenter study demonstrates that FH of CAD is independently associated with a greater coronary atherosclerotic burden and a higher prevalence of HRP features at CCTA. Nearly half of patients with very low clinical risk but positive FH showed high-risk atherosclerosis, suggesting that CCTA may enhance risk stratification and support earlier initiation of preventive therapies in this population. </span></span></p>
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