Author: Jason Curtis

Standardisation of colorectal robotic-assisted surgery (RAS) training: A roundtable discussion (2025)

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Type of publication:

Conference abstract

Author(s):

*Kawar L.; Shakir T.; *El-sayed C.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Purpose: The current landscape of colorectal robotic-assisted surgery (RAS) training is marked by significant variability. In order to gather opinions, a webinar was hosted by The Dukes' Club, the UK network for colorectal surgical trainees. This seeked to understand from a panel of expert RAS surgeons with various stakeholder roles in RAS training, the optimal method of delivering standardised RAS training in the UK. Method(s): This consensus study is based on a one-hour webinar held on 4th March 2024. Panellists included robotic surgery preceptors and proctors from both CMR Surgical (UK) and Intuitive (USA) respectively; members of robotic subcommittees within speciality associations, and providers of European fellowships. A thematic analysis was conducted to systematically analyse the qualitative data. Result(s): The roundtable featured two consultant urologists and three consultant colorectal surgeons. Four main themes with relevant sub-themes emerged: (1) the current state of robotic training, (2) training components of RAS, (3) challenges in delivering training, and (4) strategies for improvement. The discussion highlighted the variability in training based on geographical location and surgical speciality. Trainer readiness was discussed, with emphasis placed on the temporary nature of this. The importance of adopting RAS skills early in training with stepwise progression, was highlighted. Essential components of a standardised curriculum were identified including e-learning, simulation, and mentorship. Conclusion(s): Standardising colorectal RAS training is vital for equitable and effective skill development. Future directions include enhancing access and resource allocation, implementing stepwise certification, and integrating artificial intelligence and machine learning.

DOI: 10.1111/codi.70177

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Acute management of severe inflammatory bowel disease: a clinical audit for quality improvement (2025)

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Type of publication:

Conference abstract

Author(s):

*Baumert A.; *Cheetham M.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

National guidelines for the acute management of inflammatory bowel disease (IBD) have been developed to advise clinicians on first-line investigations and optimal treatment pathways. Clinical audits are vital at a trust level for identifying gaps in these pathways and creating opportunities to implement positive change. For this project, a retrospective review was carried out on patients who underwent an emergency subtotal colectomy following admission with acute severe ulcerative colitis. Surgical patients were identified via a histopathology database and elective surgeries excluded. Key points throughout each admission were audited against national standards outlined in IBD UK and the BMJ (Lamb et al, 2019). This project specifically collected data on initial investigations (stool cultures and sigmoidoscopy), medical management (steroids and biologics) and surgical intervention (first contact with surgeons and timeframe until surgery). This audit primarily identified inconsistencies in organising investigations: 37.5% of patients did not have stool cultures recorded, and sigmoidoscopy was often delayed, occurring on average 5 days post-admission. Following the results of this audit, implementations have been suggested to create a more standardised approach for initial investigations of acute flares of ulcerative colitis. Guidelines have been made more accessible, alongside informative resources explaining why these investigations are necessary. Finally, while all patients ultimately underwent surgery within an acceptable timeframe, further education has been proposed to develop a clear pathway for appropriate surgical review. We hope that easy visualisation of the IBD treatment pathway can remind clinicians when to re-assess and escalate treatment accordingly.

DOI: 10.1111/codi.70177

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STONE Score as a Triage Tool to Guide Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB) Requests in Suspected Renal Colic: A Quality Improvement Initiative (2025)

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Type of publication:

Journal article

Author(s):

*Hassouba, Omar Nasr; Abdullah Omar, Abdulaziz Alsamani; Awan, Manahil; Ahmad, Shahzad; Taha, Mawada; Venkatachalapathi, Sharmila; Abouelsadat, Mohamed K; Mercy, Albina; Sahnon, Abdelrahman Sahnon Abaker; Shafique, Usama; *Herman, Dodi I.

Citation:

Cureus. 17(9):e92080, 2025 Sep.

Abstract:

Introduction Urolithiasis is a frequent cause of emergency department (ED) visits, with computed tomography (CT) being the gold standard for diagnosis. Excessive imaging increases radiation exposure and healthcare costs. The STONE score is a validated clinical prediction tool, designed to estimate the probability of ureteric stones and reduce unnecessary imaging. Objective The main objective of this study is to evaluate the diagnostic accuracy of the STONE score in patients presenting with flank pain. Methodology This is a cross-sectional retrospective review conducted at the Shrewsbury and Telford Hospital NHS Trust (SATH), Shrewsbury, England, over a four-month period from April 1, 2023, to July 31, 2023. This quality improvement initiative reviewed 81 eligible ED patients who underwent computed tomography of the kidneys, ureters, and bladder (CT-KUB) for suspected ureteric stones. Demographic, clinical, laboratory, and imaging data were collected. STONE scores were calculated for all patients. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results The mean age was 38.5 +/- 16.1 years; 35 (43.2%) were male. Ureteric stones were confirmed in 15/19 (78.9%) high-risk, 9/45 (20%) moderate-risk, and 0/17 (0%) low-risk patients. The STONE score yielded an area under the curve (AUC) of 0.879, with a sensitivity of 91.7% and a specificity of 66.7%. Alternative diagnoses included gallbladder stones, appendicitis, cystitis, diverticulitis, hydronephrosis, renal angiomyolipoma, polycystic kidney disease (PCKD), pyelonephritis, and small bowel obstruction (SBO). Conclusion The STONE score demonstrates good diagnostic accuracy, particularly in high-risk patients, and may help reduce unnecessary CT imaging and radiation exposure in the ED.

DOI: 10.7759/cureus.92080

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A Joint Venture: Advancing Health Equity for Underserved Communities Through Integrated Dermatology–Rheumatology Clinics (2025)

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Type of publication:

Poster presentation

Author(s):

*Zal Canteenwala; *Dimple Jain; Roshan Amarasena; Joseph Thevathasan; Heli Baho; Kunal Amin

Citation:

British Journal of Dermatology, Volume 193, Issue Supplement 1, July 2025

Abstract:

Autoimmune conditions with overlapping dermatological and rheumatological manifestations present significant management challenges in rural healthcare settings. The aim of this study was to evaluate whether a newly established combined dermatology–rheumatology clinic could improve healthcare access and patient satisfaction while maintaining clinical effectiveness. This service was delivered through cross-trust collaboration between two hospitals situated approximately 30 miles apart, serving a geographically dispersed population with significant access barriers. A 6-month prospective quality improvement initiative was conducted from April to October 2022. Monthly combined consultant-led clinics were evaluated using structured questionnaires assessing patient satisfaction, operational efficiency and educational impact. The service integrated specialist care between distinct National Health Service trusts, centralizing care delivery at a single site to enhance healthcare equity for traditionally underserved rural populations. Data collection included both quantitative metrics and qualitative responses from patients attending these integrated clinics. Data were analysed using descriptive statistics, with 95% confidence intervals (CIs) calculated for key metrics. Qualitative responses were coded thematically to identify common patterns. The study demonstrated unanimous patient satisfaction at 100% (49 of 49, 95% CI 92.7–100) with the combined clinic format. Healthcare access improved significantly, with 92% (45 of 49, 95% CI 78.1–98.3) reporting reduced travel costs and 96% (44 of 46, 95% CI 85.5–99.5) citing streamlined appointment coordination. This impact is particularly significant given the region’s poor public transport infrastructure, which has seen a substantial decline in bus services over the past decade. Employment impact analysis revealed that while 31% (15 of 49, 95% CI 17.7–43.5) of patients previously required time off work for separate appointments, the combined clinic significantly reduced this burden. Qualitative analysis identified consistent themes of improved comprehensive care delivery and enhanced time efficiency. The clinic proved particularly beneficial for managing complex conditions such as psoriatic arthritis and systemic lupus erythematosus, where concurrent specialist evaluation facilitated more precise diagnostic formulation and therapeutic planning. Educational benefits were noted among participating medical students, who reported enhanced understanding of interdisciplinary care and complex disease management. In conclusion, the combined dermatology–rheumatology clinic demonstrates significant efficacy in addressing healthcare inequities in rural settings, with high patient satisfaction and operational efficiency. This cross-trust collaborative model shows particular value in managing complex autoimmune conditions requiring multispecialty input while simultaneously reducing travel burden and improving care coordination. These findings support the broader implementation of integrated specialty clinics across geographically dispersed regions, with potential applications for other specialty combinations.

DOI: 10.1093/bjd/ljaf085.095

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A Joint Venture: Advancing Health Equity for Underserved Communities Through Integrated Dermatology-Rheumatology Clinics (2025)

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Type of publication:

Journal article

Author(s):

*Canteenwala, Zal; Thevathasan, Joseph; Baho, Heli George; Amin, Kunal; *Jain, Dimple; Amarasena, Roshan

Citation:

Cureus 17(10): e94590. doi:10.7759/cureus.94590

Abstract:

Background
Patients with immune-mediated disease often need both dermatology and rheumatology input. Separate appointments can increase travel and delay decisions, particularly in rural settings. We evaluated a monthly combined clinic in a rural UK catchment.

Methods
We conducted a prospective service evaluation (April-October 2022) of a consultant-led, co-located dermatology-rheumatology clinic. Forty-nine consecutive adult attendees completed an anonymous post-visit questionnaire on perceived usefulness, satisfaction, avoided appointments, travel costs, and prior time off work; free-text responses were thematically analysed by two reviewers. We report proportions with exact Clopper-Pearson 95% confidence intervals (CIs), with denominators varying due to item non-response.

Results
We analysed 49 questionnaires. All respondents viewed the joint appointment as a good idea (49/49; 100.0%; 95% CI 92.7-100.0), and all were satisfied (47/47; 100.0%; 95% CI 92.5-100.0). The clinic avoided an additional appointment for 44/46 (95.7%; 95% CI 85.2-99.5) and reduced out-of-pocket travel costs for 39/40 (97.5%; 95% CI 86.8-99.9). Among employed respondents, 19/36 (52.8%; 95% CI 35.5-69.6) reported previously needing time off work for separate specialty visits.

Conclusions
In a rural, cross-trust NHS setting, a combined dermatology-rheumatology clinic was feasible and associated with high patient-reported usefulness and satisfaction, fewer duplicate visits, and lower travel costs. Findings support continued provision and motivate comparative and economic evaluations using routine utilisation and cost data.

DOI: 10.7759/cureus.94590

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A Case of Ventricular Standstill in Hypertrophic Cardiomyopathy: The Role of AV Block and Beta-Blockers (2025)

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Type of publication:

Conference abstract

Author(s):

*Owolabi O.H.; *Yera H.O.; *Choy C.H.; *Htet K.; *Kundu S.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A30-A33), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Introduction Atrioventricular (AV) nodal disease is a rare but serious complication of hypertrophic cardiomyopathy (HCM), often leading to conduction abnormalities. While atrial fibrillation is common, high-degree AV block (AVB) is rare. We present a case of hypertrophic obstructive cardiomyopathy (HOCM) complicated by ventricular standstill, emphasizing the need for early recognition and management. Case Presentation A 46-year-old man with a family history of HCM (mother with ICD) presented with exertional dyspnea, palpitations, and presyncope for six months. No family history of sudden cardiac death. Examination revealed HR 76 bpm, BP 115/75 mmHg, and an ejection systolic murmur. ECG showed ventricular hypertrophy, dagger-shaped Q waves, Twave inversions, first-degree AVB (280 ms), and ventricular ectopics (figures 1 and 2). Troponin and NT-proBNP were elevated. Echocardiography confirmed HOCM with severe septal hypertrophy, a maximal LVOT gradient of 43 mmHg, and systolic anterior motion of the mitral valve. Indexed left atrial volume was 48 mL/m2 (figures 3 and 4). CT coronary angiogram was normal. He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement (figure 5). He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement. Discussion HCM is the most common genetic heart disease, inherited in an autosomal dominant manner in 50% of cases. MYBPC3 mutations are frequently linked to high-degree AV block.1 While atrial fibrillation is common in HCM, highdegree AV block remains rare. First-degree AVB in HCM is increasingly recognized as a marker of disease progression and arrhythmic risk.1 Mechanisms include left atrial enlargement (predisposing to atrial fibrillation and thromboembolism) and myocardial fibrosis, promoting electrical instability.1 Our patient had a 3.1% five-year sudden cardiac death risk and developed high-degree AV block and ventricular standstill. This progression was likely exacerbated by bisoprolol, which slowed AV conduction in the setting of pre-existing firstdegree AV block. Beta-blockers, though essential in HCM management, should be used cautiously in patients with conduction abnormalities. This case underscores the need for personalized HCM management. First-degree AVB may identify high-risk individu- als requiring closer monitoring, medication adjustments, and early device therapy. Conclusion High-degree AV block and ventricular standstill are rare but significant complications of HCM. First-degree AVB may serve as an early risk marker linked to left atrial enlargement, fibrosis, and arrhythmias. Clinicians should monitor conduction abnormalities closely, especially when prescribing AV-slowing medications. Genetic evaluation, surveillance, and individualized treatment strategies are crucial for optimizing outcomes in HCM patients.

DOI: 10.1136/heartjnl-2025-BCS.33

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Lipid Management Post Myocardial Infarction: A Call for Improved Monitoring and Therapy Intensification (2025)

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Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Kukoyi B.; Joshi M.; Tran P.; Lo T.; Ajiboye J.; Oyedeji O.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A210-A211), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Background Lipid management is a cornerstone of secondary prevention in acute coronary syndrome (ACS). Despite established national guidelines, real-world practice often reveal gaps in lipid monitoring and intensification of lipid-lowering therapy. This study investigated these challenges in a large tertiary centre, proposing a streamlined pathway to address these gaps. Methods A retrospective analysis was conducted in 225 ACS patients (92 STEMI and 133 NSTEMI) from July-August 2023. We assessed lipid monitoring on admission and 2-3 months post-discharge, prescription rates of high-intensity statins and use of alternative lipid-lowering therapies. Multivariate logistic regression evaluated the relationship between highintensity statin initiation and lipid monitoring rates on admission and follow-up, adjusted for comorbidities. Results Initial guideline adherence was strong, with 83.1% having lipids checked on admission and 83.6% prescribed high-intensity statins (table 1). After adjusting for ACS type and comorbidities, patients started on high-intensity statin were nearly twice as likely to have lipids checked on admission (90.4% vs. 45.9%, p<0.001). Notably, patients not receiving high-intensity statins were more likely to have a prior history of ACS (43.2% vs 26.1%, p=0.035). Despite the perceived higher severity of STEMI, there was no significant difference in post-discharge lipid-checking rates between STEMI and NSTEMI patients (51.1% vs 53.4%, p=0.735). In terms of follow-up, only 52.4% of patients had lipids rechecked post-discharge, leaving almost half without adequate monitoring. Neither high-intensity statins nor ezetimibe initiation increased the likelihood of follow-up lipids. Among 118 patients with follow-up lipid assessment, 69.5% achieved target levels. However, of the 36 patients (30.5%) not meeting targets, only 3 (8.3%) had therapy intensified limited to the use of ezetimibe, highlighting a critical gap in care. Conclusion This study highlights the dichotomy between strong initial guideline adherence and significant lapses in follow-up care and therapy intensification. Whilst this single- centre study limits generalisability, several interesting observations emerged. The association between high-intensity statin prescription and admission lipid check highlights the importance of fostering a culture of guideline adherence, where attention to one aspect of care positively influences others. Patients with prior ACS were less likely to receive high-intensity statins, potentially due to perceived stability on existing regimen, leading to missed opportunities for therapy intensification. More strikingly, nearly half of the cohort lacked adequate lipid monitoring on follow-up with restricted use of lipid-lowering therapies. This highlights the need for a structured approach involving cardiac rehabilitation and primary care team via the proposed pathway (Figure 1) to ensure better lipid management in this high-risk cohort.

DOI: 10.1136/heartjnl-2025-BCS.206

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Evaluation of practice patellofemoral instability collaborative (EPPIC) (2025)

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Type of publication:

Journal article

Author(s):

Kosy J.; Thomas W.; Higgin R.; Thomas J.; Odeh A.; Archer J.; Bache C.E.; Gaffey A.; Buddhdev P.; Bosman H.; Tun Ngu A.W.; Stringfellow T.; Lebe M.; Parikh S.; Sanalla A.; Khan W.; Tennyson M.; Hislop S.; Lenihan J.; Ahmed Almustafa M.A.; Baskaran D.; To K.; Hughes W.; Butt M.M.; Venkatesh R.; Dawood L.; Archer D.; Jamjoom A.; Reddy G.; Anand S.; Rajput V.; Akrawi H.; Loeffler M.; AL-Sukaini A.; Ramasamy A.; Syed S.; Khan M.; Thonse R.; Paramasivan A.; Morton R.; Mahmood A.; Luo W.; Umer H.M.; Haslam P.; Hancock G.; Servant C.; Gill J.; Karssiens T.; Wood R.; Bowditch M.; Deo H.; Barwell J.; Hourston G.; Wyatt D.; Chen A.; Williams J.; Sivaprakasam M.; Young J.; Khwaja M.; Sleiman S.; Bowman N.; Napier R.J.; Finlayson G.; Jones K.; Blyth M.J.; Hopper G.P.; Wheelwright B.; Dalgleish S.; Davies P.S.E.; Sinnerton R.J.H.; Banziger C.; Abell A.; McNamara I.; Hasan R.; Liew I.; Archunan M.; Watts D.; Subhash S.; Negus O.; Muller S.; Irvine S.; Bottomley N.; Woods A.; Bretherton C.; Myatt R.; Paul C.; Gacaferi H.; Smith J.; Newman J.; Cohen A.; Cruickshank J.; Kahn R.; Matheron G.; Patel J.; Crane E.; *Roach R.; *Kabariti R.; *Khaleeq T.; Rushbrook J.; Morcos Z.; Thiruchandran G.; Barrett-Lee J.; Bailey L.; Subramanian S.; Britton J.; Tindall A.; Cheema K.; Oluku J.; Saleh A.; Chahal J.; Fernandes A.; Papadopoulus D.; Dellis S.; El-Raheb K.; Akintade A.; Saraglis G.; Mitchell S.; Leow J.M.; Mandalia V.; Skinner E.; Middleton S.; Schranz P.; Gillespie G.; Howard J.; White T.; Makaram N.; Simpson C.; Johnstone P.; Akhtar K.; Karam E.; Ferguson D.; Cuthbert R.; Wickramarachchi L.; Liang K.; Bhutta A.; Havenhand T.; Hoggett L.; Rogers G.; Waugh C.; Cowie J.; Ashraf T.; Sweed T.; Mussa M.; Dong H.; Ashraf Y.; Stoddard J.; Jayasuriya R.; George H.; Craik J.; Rose L.; Wei R.; Clark D.; Donovan R.; Shiels S.; Tilston T.; Johnson D.; Baigent T.; Iqbal K.; Mughal E.; Dewan V.; Chauhan G.; Habeebullah A.; Bleibleh S.; Kaur J.; Thanikachalam P.; Metcalfe A.; Weiyun W.N.; Krishnan H.; Eldridge J.; Beaumont O.; Sheath P.C.; Stoneham A.; Morley W.; Gibson C.; Fraig H.; Bowen D.; Hossain F.; Sur H.; Sherbaz S.; Osman K.; Khadabadi N.; Saleemi A.; Arif M.; Moores T.; Nicolai P.; Sibbel J.; Nabulyato W.; Pathan A.; Mcgarvey C.; Ahmed M.; Logishetty K.; Al-Hourani K.; Baileyi M.; Hingi C.

Citation:

Knee. 57 (pp 325-334), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background: The management of patellofemoral instability in the United Kingdom remains poorly standardised. Through the British Association for Surgery of the Knee trainee collaborative, we aimed to identify which procedures (and in which combination) were being used to surgically manage this common condition across the UK. Method(s): A retrospective national audit was conducted via a trainee collaborative analysing local trust data between 1st January 2014 and 31st December 2019. Data from institutions registered for the EPPIC audit was compiled and analysed for degree of compliance against more recently published national guidelines. Result(s): Fifty (n = 50) sites submitted data, totalling 3189 skeletally mature patients. The median age was 26.7 (SD 0.5) years and 63.3 % were female. An isolated lateral release was performed in 8 %, an isolated medial patellofemoral ligament reconstruction (MPFLR) was performed in 37 % of patients and proximal realignment surgery was conducted in 8 % of patients. Trochleoplasty was required in 11 % of patients, with combined MPFLR and tibial tubercle osteotomy (TTO) being undertaken in 22 % of patients. Combined MPFLR, TTO and trochleoplasty was undertaken in 3 % of patients. Conclusion(s): This audit highlights the national variation in surgical treatment of a common orthopaedic presentation. Despite the lack of evidence, an isolated lateral release is still being performed. There remains a lack of standardisation within the UK in the management of recurrent patellar instability, highlighting the need for national consensus of appropriate surgical interventions.

DOI: 10.1016/j.knee.2025.06.015

Bronchiolitis Obliterans in an Adult Male After Admission With Panton-Valentine Leucocidin Staphylococcal Pneumonia (2025)

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Type of publication:

Journal article

Author(s):

*Nadeem, Sabha; *Sargent, Georgina; *Wood, Gordon; *Ahmad, Nawaid.

Citation:

Cureus. 17(9):e91611, 2025 Sep.

Abstract:

A middle-aged man with no smoking or respiratory history presented with shortness of breath and facial swelling due to influenza. His condition deteriorated rapidly, and he required intensive care admission and intubation. He was found to have Panton-Valentine leucocidin (PVL) Staphylococcal pneumonia, with bilateral pneumothorax and subcutaneous emphysema. He responded well to antibiotics and chest drainage and was subsequently discharged. His follow-up radiology initially showed almost complete resolution. However, over the course of five years, he had multiple GP attendances and hospital admissions for recurrent infections with continued breathlessness on exertion. A follow-up CT suggested features of bronchiolitis obliterans (BO), which has not been previously recognised as associated with PVL Staphylococcal infections. Specialist teams have suggested active observation with consideration of transplantation in the event of deterioration. This case demonstrates that BO can be seen with previously unrecognised infectious aetiology and should be considered in any patient with appropriate symptomatology following a severe respiratory infection.

DOI: 10.7759/cureus.91611

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CT coronary angiography in the lipid clinic: a pilot study and lipidologist survey (2025)

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Type of publication:

Journal article

Author(s):

Graby, John; Sellek, James; Khavandi, Ali; Thompson, Dylan; Loughborough, Will W; Hudson, Benjamin J; Avades, Tony; Mbagaya, Wycliffe; Luva, Ahai; *Capps, Nigel; Shirodaria, Cheerag; Bayly, Graham; Antoniades, Charalambos; Downie, Paul F; Rodrigues, Jonathan C L.

Citation:

The International Journal of Cardiovascular Imaging. 2025 Oct 09. [epub ahead of print]

Abstract:

Guidelines recommend considering coronary calcium score (CCS) in asymptomatic patients to aid risk stratification. However, calcification occurs late in atherosclerosis. Coronary CT angiography (CCTA) can detect non-calcific plaque and inflammation before calcification develops, but impact on clinical management is not well documented. We compare coronary artery disease (CAD) detection and grading between CCS and CCTA, impact on management, and explore CCTA-derived inflammation biomarker (pericoronary fat attenuation index [FAI]) in the lipid clinic. Exploratory analysis of a prospectively maintained database of lipid clinic patients with CCS and CCTA (2018-2020). CCS grade was compared with CCTA stenosis, presence of high-risk plaque (HRP) and FAI-score analysis. UK Consultant Lipidologists completed an anonymised survey, documenting lipid target and management after sequential unblinding of CCS and CCTA data. In 45 asymptomatic patients (49% female, mean age 55 +/- 9), CCTA re-classified CAD presence in 22% (p = 0.002) and severity in 62% (p = 0.005) vs. CCS. HRP was observed in 20% (9/45), including 56% with CCS <= 100. Median LDL target with clinical vignette was 101 mg/dL (IQR 77-120), reducing to 89 mg/dL (77-120) after CCS, and 77 mg/dL (70-116) after CCTA unblinding. CCS altered LDL target in 12%, and CCTA a further 19% (chi2 57.0, p < 0.005). High FAI-score was demonstrated in 20%, including 22% of those with CCS <= 100 and 75% of those with <= mild CAD on CCTA. CCTA increased CAD prevalence and re-classified severity versus CCS, altering hypothetical management. High FAI-scores were observed across CCS and CCTA severity grades, including patients with no overt CAD.

DOI: 10.1007/s10554-025-03526-3

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