Adding Coronary CT Angiography to Annual Firefighter Physicals Could Save Lives

MONTREAL, Canada—Incorporating coronary computed tomography angiography (CCTA) with quantitative coronary plaque analysis (QCPA) into the annual physical of firefighters allows for the early detection of cardiovascular disease in this high-risk population, new research shows.

Among more than 300 young, fit firefighters, CCTA led to 3.6% undergoing a diagnostic cath and 28.6% being referred to a cardiologist for medical or lifestyle management. Among the two-thirds with zero coronary artery calcium, more than four in five had noncalcified plaque identified, including two with obstructive lesions who received PCI.

Researchers said they were startled by the findings. 

“We figured that a couple would [have] a calcium score of zero but some plaque, but to have 83% with a calcium score of zero and noncalcified plaque was so surprising,” co-principal investigator Carrie Burns, MD (South Metro Fire Rescue Wellness, Centennial, CO), told TCTMD. Burns was particularly taken aback by the two firefighters with obstructive lesions in need of PCI.

“Sudden cardiac death is the leading cause of death in firefighters nationally, and it accounts for 40% of all line-of-duty deaths,” co-principal investigator Jeremy Gage, PA-C (South Metro Fire Rescue Wellness), told TCTMD, adding that the SCOT-HEART trial inspired his team to look at how CCTA might improve the health of firefighters.

The findings were presented Friday in a poster session during the 2025 Society of Cardiovascular Computed Tomography (SCCT) meeting.

Urgent Patients Found

The team performed CCTA with AI-enabled QCPA (Cleerly Labs) on 309 firefighters (mean age 47 years; 96.1% male) undergoing yearly mandated physical exams that also included measuring CV risk factors and hemoglobin A1C. To undergo CCTA, firefighters had to be at least 40 years old or have at least one CV risk factor. Researchers calculated PREVENT scores for all participants as well.

CAC was identified in 34% of firefighters, with a median score of 35, and CCTA found CAD in 88% of them. Among those with no CAC, 83.3% had noncalcified plaque, including two with stenoses > 50%).

QCPA identified severe coronary artery disease (percent atheroma volume ≥ 5%) in 9.1%. Nonobstructive CAD made up the majority (90.2%) of coronary plaque, but 11 firefighters (3.6%) had moderate or severe stenosis and underwent invasive coronary catheterization, nine of whom underwent PCI. More than one-quarter of firefighters (28.6%) were referred to cardiology for further lipid management.

Interestingly, the PREVENT score did not accurately identify those who would have CAD on CCTA, as only 13 of the 278 firefighters (4.7%) with plaque had a score over 5%.

“The calcium score as well as the PREVENT score really were not good enough” for identifying at-risk firefighters, Gage said.

Burns said what has been most gratifying is seeing the handful of patients who had urgent disease identified in the study taking control of their health. “I have a little peek into our 1-year data, and it’s so nice to see the patients come to their appointments,” she said, adding that they’re interested in their labs and taking medications. “This is a group who’s very . . . medication phobic.”

Another hurdle faced in this specific population was concerns over job loss if disease was identified on the CCTA, Burns said, adding that she had to reassure many participants they would not lose their job over any findings, but also say, “If you have an event and if you survive at minimum, you won’t be working for 3 months.”

The team has extended their screening program for another year, dropping the minimum age for CCTA to 35 years and adding Lp(a) measurements to the protocol. They plan to follow up on lab work annually to see if lipid markers improve as well as if the CCTA drives medication compliance.

“I think it does,” Gage said. “We don’t have the numbers yet, but just talking to patients one-on-one, [many have] decided to make changes.”