LAUSR

Introduction Computed tomography coronary angiography (CTCA) is increasingly requested in asymptomatic patients with familial hypercholesterolaemia (FH) to risk stratify and determine cholesterol management strategies. Currently there is no consensus regarding the value of calcium scoring or CTCA for this purpose. We sought to evaluate how often CTCA leads to positive changes in management in this patient group. Methods As part of a wider quality improvement project on CTCA use at a tertiary centre in London, we retrospectively identified patients referred for CTCA from the lipid clinic with confirmed FH between 2015 and 2019. Patient records were reviewed to determine clinical outcomes following CTCA. CTCA reports were scored as having coronary artery disease (CAD) if at least one mildly stenotic plaque (>25%) was identified. Results We identified 42 patients with FH and a CTCA, of which 24 were asymptomatic. 14 had CAD, with most having plaque in the LAD (LMS=2; LAD =13; LCx = 6; RCA = 10). As a result, 10 patients (71.4%) had intensification of their cholesterol management and half (n=7) were initiated on novel PCKS9 inhibitors. The remaining 4 patients with CAD and those with no CAD (n=10) continued on the same treatment without de-escalation. 3 patients had downstream testing for ischaemia. Conclusion In this small case series, we find supporting evidence that CTCA leads to a positive change of management in asymptomatic patients with FH once coronary anatomy is known. Further studies on cost effectiveness, safety and outcomes are needed before this practice can be widely recommended.