Coronary artery disease often develops silently, making early detection crucial for preventing adverse cardiovascular events. This study was presented at the European Society of Cardiology Congress 2025. 

Data from 2,180 patients across five centers in Greece were analyzed to assess the clinical use of coronary computed tomography angiography (CCTA) and its ability to identify coronary atheromatosis and inflammation. Notably, 59% of patients referred for CCTA were asymptomatic, highlighting the growing role of imaging beyond symptomatic evaluation. Overall, 37.2% of participants had non-obstructive coronary artery disease, while 21.7% had obstructive disease. 

Even among patients without standard modifiable risk factors, nearly 30% had non-obstructive disease and 10% had obstructive disease, revealing hidden cardiovascular risk in presumed low-risk populations. In a nested analysis of 357 patients without obstructive disease, approximately one in four individuals exhibited high coronary inflammation, as measured by the fat attenuation index, demonstrating early vascular changes that may precede clinical events.

These results emphasize the utility of CCTA in uncovering subclinical coronary disease and vascular inflammation, even in asymptomatic individuals and those without conventional risk factors, supporting its integration into preventive cardiovascular care and personalized risk stratification strategies.