Investigators in a new study find that coronary computed tomography angiography (CCTA) may be useful in primary prevention of coronary events. Göran Bergström, MD, PhD, from the Sahlgrenska University Hospital and Gothenburg University, Sweden, presented these findings during a late-breaking clinical science session on Sunday at the American Heart Association (AHA) Scientific Sessions 2025 in New Orleans. Results were published simultaneously in a manuscript in the Journal of the American Medical Association. Investigators in this trial examined how CCTA impacts risk prediction in primary prevention of coronary events, particularly myocardial infarction (MI) and cardiovascular death. Typically, traditional risk scoring involves patients’ sex, age, cholesterol, blood pressure, smoking status and diabetes status. Coronary artery calcium scoring is also used to predict coronary events. Little data is available for the use of CCTA in primary prevention. Participants in this study were randomly invited from the general population (n=24,791; 50-64 years old; 50% women). Patients did not have previous MI, revascularizations or stroke. Risk factors were calculated using the risk score (PCE), computed tomography (CT) and CCTA using Siemens Somatom Flash. Coronary events were considered the first occurrence of nonfatal myocardial infarction or death from coronary heart disease. Patients were followed for a median of 7.8 years and a total of 304 coronary events took place within that time frame. Patients who were evaluated with PCE or PCE plus CT had fewer events predicted than patients who received PCE plus CT plus CCTA. Patients who received PCE plus CT also had fewer events predicted than patients with PCE plus CT plus CCTA, but more than those who just received PCE. Reclassification improved with the use of CCTA as well. These rates were lower in the other two groups. Overall, CCTA may be valuable in predicting risk factors for primary prevention of coronary events. “Data from CCTA reclassified risk, however, the observed absolute risk in the population was low and reclassification occurred in the low-risk group (<5% ten-year risk of [atherosclerotic cardiovascular disease] ASCVD by PCE),” Dr. Bergström said during his presentation at AHA. “Therefore, the clinical value of adding CCTA to improve risk prediction needs to be further evaluated in populations at higher risk, in subgroups and in parallel with a health economic evaluation.” Source: Bergström G, Engström G, Björnson E, et al. Coronary computed tomography angiography in prediction of first coronary events. JAMA. 2025 November 9. 10.1001/jama.2025.21077 Image Credit: VectorMine – stock.adobe.com