Study Background and Disease Burden
Chest pain is a common clinical presentation that often signals underlying coronary artery disease (CAD), a leading cause of morbidity and mortality worldwide. Stable chest pain evaluation aims to identify patients at risk of myocardial infarction (MI) and death. However, the optimal initial diagnostic strategy remains debated. Coronary computed tomography angiography (CTA) offers a non-invasive visualization of coronary anatomy and plaque burden, potentially allowing better risk stratification than functional testing alone. Despite growing use, whether CTA improves clinical outcomes across all risk groups is unclear. The risk factor weighted clinical likelihood (RF-CL) model estimates patient-specific probability of obstructive CAD by integrating traditional cardiovascular risk factors and symptoms, offering refined pretest risk stratification.
Advancing beyond standard plaque burden assessments, radiomics-based phenotyping characterizes nuanced plaque morphology, potentially improving prediction of myocardial infarction beyond conventional clinical and imaging metrics. The PROMISE and SCOT-HEART trials provide robust data on the prognostic value of coronary CTA and novel radiomic approaches in stable chest pain patients.
