How fatal heart attacks could be predicted years in advance with new technology A new method of reading routine heart scans that can pinpoint those most at risk proved successful in its first major trial.

Fatal heart attacks could be predicted years in advance after a new method of reading routine heart scans that can pinpoint those most at risk proved successful in its first major trial.

The technology, based on analysis of computed tomography (CT) coronary angiograms, will “undoubtedly” save lives, according to its creators.

Heart attacks are usually caused by inflamed plaques – fatty deposits on artery walls – rupturing and blocking blood flow to the heart. The challenge for doctors is knowing which plaques are most likely to cause blockages, and therefore which patients should be treated with more aggressive therapies.

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In the UK, someone has a heart attack every seven minutes. Doctors currently hope to identify the highest risk patients so they can be given preventative treatment and advised to adopt lifestyle changes.

An international team of researchers has shown that the most dangerous plaques release chemical messengers which modify the surrounding fat. They have developed a technology that detects the inflamed plaques that are prone to cause heart attacks by analysing CT images of the fat surrounding the arteries.

Their Fat Attenuation Index (FAI) has been tested for the first time in a large study published in The Lancet journal. Some 3,900 patients from Erlangen, in Germany, and at the Cleveland Clinic, US, were followed for up for ten years after they had a CT coronary angiogram.

The FAI technology was found to predict fatal heart attacks many years before they happen, with a “significantly superior predictive accuracy” compared with other methods. People with abnormal FAI had up to nine times higher risk of having a fatal heart attack in the next five years.

“These patients would be the ideal candidates for aggressive medical therapy to prevent this from happening,” the research team, who presented their findings at the European Society of Cardiology congress in Munich, said.

No method

More than 100,000 people die from a heart attack or related stroke in the UK every year, yet there is no method that allows for early detection of a potentially fatal build-up of plaque that could trigger a heart attack.

Professor Charalambos Antoniades, from the University of Oxford who led the study, said: “This new technology may prove transformative for primary and secondary prevention. For the first time we have a set of biomarkers, derived from a routine test that is already used in everyday clinical practice, that measures what we call the ‘residual cardiovascular risk’, currently missed by all risk scores and non-invasive tests.

“Knowing who is at increased risk for a heart attack could allow us to intervene early enough to prevent it. I expect these biomarkers to become an essential part of standard CT coronary angiography reporting in the coming years.”

Professor Metin Avkiran, associate medical director at the British Heart Foundation – which funded the research, said: “Most heart scans are good at spotting blockages caused by large plaques, but not the smaller, high-risk plaques that are likely to rupture and cause a heart attack.

“This new technique could be a game changer – allowing doctors to spot those ‘ticking time bomb’ patients who are most at risk of a heart attack, and getting them on to intensive treatment. This would undoubtedly save lives.”