LAUSR

The very interesting study by Tomizawa et al. [1] recently published on this journal, has proposed a new scoring system calculated from demographic characteristics and cardiovascular risk factors to detect “high-risk” plaque assessed by coronary computed tomography angiography (CCTA). Patients located in the high-risk group had a high prevalence of high-risk plaque. A sort of concern arises from the fact that patients included in this study underwent to CCTA regardless of chest pain. Notably, the presence of high-risk plaques is prognostically important independently of the symptoms also because those are often hemodynamically not significant [2]. However, the appropriate use criteria for detection of CAD in asymptomatic patients are indicated by current guidelines as “uncertain” [3]. In terms of event prediction, our thought is that the model that includes only the standard CV risk factors is not strong enough to correctly identify the asymptomatic patients with a very high risk coronary profile who will occur in hard cardiac events. We previously demonstrated [4] that the subgroup of asymptomatic and male patients at intermediate-risk, with diabetes mellitus, carotid artery disease, and increased interleukin 6 levels had very high rates of obstructive CAD and high-risk plaque. Therefore, given the strong prognostic ability of CCTA [5] and in light of the dramatic reduction of