High-risk coronary atherosclerosis at CCTA in patients with Family histoRy of coronary Artery disease: An InTERnational Multicenter Study (The FRATER Study)

Introduction: No previous data specifically addressed the prevalence and distribution of coronary atherosclerosis in patients with family history (FH) of CAD. Aim of the present multicenter study was to explore the prevalence of atherosclerosis at coronary computed tomography angiography (CCTA) among patients with or without FH of CAD. Material and methods: We performed a retrospective analysis of multicenter observational study including a consecutive cohort of patients who prospectively underwent clinically indicated CCTA for suspected CAD. A group of patients with FH of CAD were matched in a 2:1 fashion with a control group without FH of CAD from the same consecutive cohort. All CCTA were evaluated in a core lab for advanced atherosclerosis evaluation and quantification. Differences in prevalence of atherosclerosis at CCTA were reported and compared between patients with or without FH of CAD. Results: A total of 480 patients were enrolled, 160 with FH of CAD and 320 without (mean age 61.7±9.6, female prevalence 41.9%). Clinical characteristics did not differ between the two groups, but the prevalence of high-risk atherosclerosis was significantly higher among those with FH of CAD (62% vs. 43%, respectively, p=0.0001). Among patients clinically classified as very low probability of obstructive CAD, high-risk atherosclerosis or obstructive CAD was found at CCTA in 42% of those with FH of CAD vs. 19% of those without (p=0.0009). Conclusion: This prospective multicenter study shows that patients with a family history of CAD have a higher prevalence of high-risk atherosclerosis. Moreover, nearly half of those with very-low pre-test probability of obstructive CAD and a family history of CAD had high-risk atherosclerosis at CCTA.