Heart Attack Screening Tools Miss Nearly Half of At-Risk Patients

The Hidden Danger of False Security

A groundbreaking study from Mount Sinai researchers has exposed a critical flaw in how doctors assess heart attack risk, revealing that current medical screening techniques could be failing to catch nearly half of those who experience a heart attack . The research, published in the Journal of the American College of Cardiology: Advances, analyzed health records of 474 people aged 65 or younger who had been treated for their first heart attack between January 2020 and July 2025.

The implications are staggering. If these patients had been evaluated just two days before their heart attack, nearly half would not have been recommended for further testing or preventive therapy according to current screening guidelines. This means millions of people worldwide may be walking around with a false sense of security about their heart health.

When Standard Risk Calculators Fall Short

Doctors currently rely on two primary tools to assess cardiovascular risk: the widely used ASCVD (atherosclerotic cardiovascular disease) score and the newer PREVENT calculator. The ASCVD score is calculated during annual check-ups for those aged between 40 and 75, determining the risk of a heart attack or stroke within the next 10 years based on contributing factors such as blood pressure, cholesterol, age, sex, and race .

However, the Mount Sinai study found that 45% of patients were classified as low or borderline risk, which do not qualify for preventive treatment or further testing under current guidelines . Even more concerning, the newer PREVENT tool classified 61% of patients who had a heart attack two days later as belonging to the low or borderline risk groups .

Dr. Anna Mueller, the study's first author and an internal medicine resident at Mount Sinai, explains the troubling pattern: "When we look at heart attacks and trace them backwards, most heart attacks occur in patients in the low or intermediate risk groups" . This reality challenges the fundamental assumption that low-risk scores provide safety assurance.

The Silent Killer Within

Perhaps most alarming is the timing of symptoms. The research revealed that 60% of patients did not develop any symptoms until less than two days before the heart attack . This finding undermines the current approach of waiting for warning signs like chest pain or shortness of breath before taking action.

The problem lies in what researchers call "silent plaque" – dangerous atherosclerotic buildup in arteries that remains undetected by traditional risk assessments. A person can appear "low risk" on paper while having dangerous build-up in their arteries growing silently. This hidden build-up, known as plaque, can suddenly rupture and block blood flow to the heart, causing a heart attack without warning .

A New Vision for Prevention

The researchers advocate for a fundamental shift in how medicine approaches heart attack prevention. Instead of relying solely on risk calculators and symptom monitoring, they propose focusing on direct detection of arterial plaque through advanced imaging techniques. "Doctors should shift their focus from detecting symptomatic heart disease to detecting the plaque itself for earlier treatment, which could save lives" , Mueller emphasizes.

Dr. Amir Ahmadi, the study's corresponding author and a cardiologist at Mount Sinai, believes "it may be time to fundamentally reconsider this model and move toward atherosclerosis imaging to identify the silent plaque—early atherosclerosis—before it has a chance to rupture" . This approach could revolutionize cardiovascular care by catching dangerous plaque buildup years before it becomes life-threatening.

While more research is needed to refine these new screening approaches, this study serves as a crucial wake-up call. The current system's failure to identify nearly half of future heart attack victims suggests that many preventable deaths may be occurring simply because we're looking in the wrong places for danger signs.