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Background: National Cholesterol Education Program (NCEP) guidelines have been used to define treatment goals in patients with hypercholesterolemia. However, epidemiology-based guidelines are unable to identify all subjects with coronary artery disease for aggressive lipid intervention. Objective: We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment. Methods: Multislice computed tomography was performed in 114 consecutive patients (mean age 57±14 y; 59% male) without known coronary artery disease. Subjects were classified into 3 categories (low-, intermediate-, and high-risk) according to their Framingham risk scores (FRS). Results: Traditional cardiac risk factors were common: hypertension 59%, diabetes 13%, and smoking 22%. On the basis of the FRS, 11% (n = 12/114) of the patients met high-risk criteria requiring aggressive cholesterol reduction. Of those in the low-and intermediate-risk groups, MSCT found coronary plaque in 76% (n = 77/102), with moderate or severe plaque in 38% (n = 39/102), thus reclassifying them in the high-risk category. Use of statin drugs increased from 32% at baseline to 53% (p = 0.002) based on MSCT results; statin dose was increased in 31% of the patients who were already on a statin. The mean low-density lipoprotein cholesterol (LDL-c) decreased from 114 mg/dL to 91 mg/dL after MSCT (p<0.001). Conclusion: Multislice computed tomography reclassifies a high percentage of patients considered to be lowto intermediate-risk into the high-risk category based on their coronary artery lesions. Thus, the rise in MSCT use at present may have a large impact on clinician practice patterns in lipid-lowering therapy.

Objective: To summarize published case reports of aortocoronary arteriovenous fistula (ACAVF) after coronary artery bypass grafting surgery (CABG). Background: Inadvertent ACAVF is a rare complication following CABG. However, the incidence continues to rise, and its management details and clinical outcomes have not been well described. Methods: To identify all published cases of ACAVF following CABG, PubMed, EMBASE, and Scopus were searched through November 2019. We defined ACAVF as inadvertent attachment of the grafting vessel onto a cardiac vein instead of targeted coronary artery. A systematic review was performed to identify the incidence, clinical features, and management outcomes. Results: A total of 48 post-CABG ACAVF cases were gathered. Among these patients, the mean age was 61.9 years and 79.2% were men. Most common presenting symptoms were chest pain (60.4%) and dyspnea (27.1%). The average onset of symptoms was 3 years; however, 54.2% of patients developed symptoms within the first year. The majority of cases reported targeted native vessel LAD during CABG (62.5%). Of these cases, 9 (18.8%) were managed conservatively, 8 (16.7%) chose to undergo surgery including ligation of fistula and repeat CABG, and 27 (56.3%) underwent percutaneous closure. Among these patients 13 cases (27.1%) were managed with coil embolization, 5 (10.4%) with balloon embolization, 5 (10.4%) were treated with a covered stent, and 4 (8.3%) used a vascular plug. There were no reported complications following treatment in this group. Conclusions: Inadvertent ACAVF are rare following CABG. Percutaneous closure was feasible and safe in treating these patients.

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