A staging system for coronary artery disease, based on levels of plaque in the blood vessels, may help people begin treatment earlier and prevent cardiac events.

Coronary artery disease (CAD) occurs due to plaque buildup in the heart’s arteries. The plaque causes a narrowing, or stenosis, of the arteries, which reduces or blocks blood flow. This is atherosclerosis, and it can increase the risk of heart attack.

Researchers are currently investigating a staging system for CAD, which measures the buildup of plaque to identify the risk of cardiac events, rather than the current strategy, which assesses risk factors.

This article looks at how staging may help CAD and adverse cardiac events, how the staging system might work, and when it may be in use.

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According to a 2022 study, staging plaque in atherosclerosis may help doctors identify the type and extent of CAD, which may help predict the risk of major adverse cardiac events (MACE).

This may help people begin treatment earlier and prevent serious cardiac events.

Currently, the main prevention strategy for cardiovascular disease is identifying risk factors, including:

The problems this causes are:

  • Those with higher risk may begin preventive treatment even if they do not have atherosclerosis.
  • Individuals without risk factors may have significant atherosclerosis without receiving preventive treatment.

The current strategy is also unable to identify how well treatment is working.

There is an upward trend in the cardiovascular death rate in the United States.

Treatments that can prevent cardiovascular events are available, and there is also evidence that screening people with no symptoms reduces cardiovascular events.

Implementing a staging system to identify the level of atherosclerosis aims to better identify individuals with atherosclerosis who are at risk of cardiovascular events.

The TRANSFORM trial is currently underway to test whether care based on a CAD staging system reduces cardiovascular events compared to a risk-factor-based strategy.

The researchers estimate the trial will take 5 years and will end in 2029.

Doctors use a coronary computed tomography angiography (CCTA) scan to identify a narrowing of the blood vessels connecting to the heart. This can help doctors see how much plaque buildup there is.

A CCTA scan uses X-rays to create images of the heart and blood vessels. A computer then creates a 3D image of the heart.

Doctors use a contrast dye to show blood flow to the heart. This can show if there is any reduced or restricted blood flow in the heart arteries.

A 2022 study proposes using CCTA scans and computer software to measure total plaque volume to provide a CAD stage.

A 2022 study defined four stages of CAD based on the levels of coronary atherosclerotic plaque.

The researchers used CT scans and coronary computed tomography angiography (CCTA) to identify plaque levels.

The researchers found an increased link between stenosis, a narrowing of the arteries, and ischemia, reduced blood flow, with increased levels of plaque.

The table below outlines the stages of CAD the researchers propose based on their findings.

0No plaque: The measurements for stage 0 were 0 mm3 total plaque volume (TPV) and 0% atheroma volume (PAV).
1Mild plaque: Most people in this stage were non-ischemic. The measurements for stage 1 were >0–250 ​mm3 TPV and >0–5% PAV.
2Moderate plaque: The measurements for stage 2 were >250–750 ​mm3 TPV and >5–15% PAV.
3Severe plaque: A large majority of individuals in stage 3 were ischemic. The measurements for stage 3 were >750 ​mm3 TPV and >15% PAV.

People with Stage 2 and Stage 3 CAD may have an increased risk of MACE over 10 years compared to individuals in stage 0 and stage 1.

The staging system may help doctors identify the long-term risk of MACE due to CAD, and people may be able to start preventive treatment earlier on.

Researchers hope the CAD staging system will allow individuals to implement care based on their risk factors for CAD, which is particularly important for people with no symptoms. This may help reduce cardiac events.

Researchers are currently investigating a new staging system for CAD, which measures total plaque volume to assess the extent of atherosclerosis and the risk of cardiac events.

This may help people begin preventive treatment earlier and prevent cardiac events due to atherosclerosis.