On the role and place of computed tomography of coronary arteries in screening and early detection of cardiovascular disease

Background. Within the framework of the National Healthcare Project and the Federal project "Combating Cardiovascular Diseases," increasing the volume of endovascular interventions is a key priority. Multispiral computed tomographic coronary angiography (MSCT-CA) is a noninvasive alternative to traditional coronary angiography with high diagnostic accuracy for coronary artery disease (CAD) and atherosclerosis of various localizations. MSCT-CA implementation has been hindered by organizational and methodological barriers and lack of clearly defined role in cardiology diagnostic algorithms.

Objective. To demonstrate the role and place of MSCT-CA in screening and early detection of cardiovascular diseases using a clinical case of an asymptomatic patient with multifocal cardiac and vascular pathology.

Materials and methods. A clinical case of patient M., 68 years old, who presented to V.P. Polyakov Samara Regional Clinical Cardiology Dispensary in November 2020 for CT follow-up after COVID-19 pneumonia (38% lung involvement). Chest CT revealed significant coronary artery calcification. Medical history: arterial hypertension for 5 years (maximum BP 200/110 mmHg), hypertensive crises with dizziness, situational antihypertensive therapy. No prior cardiac evaluation, no angina symptoms. MSCT-CA with contrast enhancement of coronary arteries and brachiocephalic trunk (BCT) arteries was performed.

Results. MSCT-CA revealed hemodynamically significant stenoses: left anterior descending (LAD) artery up to 75%, posterior descending and diagonal arteries up to 90%, and right internal carotid artery (ICA) stenosis up to 78%. Verification invasive coronary angiography confirmed critical LAD-diagonal artery bifurcation stenosis Medina (1-1-1) 99-75-99% with aneurysm and severe arterial wall calcification. LADdiagonal artery stenting was performed with two coronary stent implantation. Uncomplicated postoperative course. Dual antiplatelet therapy (aspirin 100 mg + clopidogrel 75 mg), statins 40 mg, antihypertensives, and β-blockers were prescribed. Elective right eversion carotid endarterectomy under general anesthesia was performed. Intraoperatively, atherosclerotic plaque with thrombosis was identified. ICA clamping time 25 minutes. Uneventful postoperative course, discharged on day 5. The regional program "Healthcare Development of Samara Region 2021-2030" includes MSCT-CA provision beyond basic mandatory health insurance with annual funding of 20 million rubles (≈3,100 additional studies).

Conclusions. MSCT-CA is an effective noninvasive screening method for early detection of coronary and brachiocephalic artery atherosclerosis in asymptomatic patients with risk factors (age >60 years, arterial hypertension, post-COVID-19). The method enables timely patient selection for invasive CAG and revascularization, medication therapy adjustment, and initiation of follow-up care. MSCT-CA inclusion in examination programs accelerates clinical decision-making and contributes to reducing mortality from myocardial infarction and circulatory diseases. Organizational strategy should include MSCT-CA reference center development, outpatient registry formation for patients with examination indications, and additional financial support. 

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