Prognostic Value of Cardiac Computed Tomography Angiography in Patients with Suspected Coronary Artery Disease: A Meta-Analysis

Abstract

Objectives: The diagnostic accuracy of cardiac computed tomography angiography (CCTA) is well reported. The prognostic value of CCTA has been described in several studies, but many of these were underpowered and an update of the meta-analysis is necessary to increase the power to predict rare events.The purpose of this study was to perform a meta-analysis of the ability of CCTA to predict future cardiovascular events. Methods: We searched multiple databases for longitudinal studies of CCTA with a follow-up of at least 12 months of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), death, myocardial infarction and revascularization. Summary test parameters and receiver-operating characteristic curves were calculated. Results: Eighteen studies evaluated 29,243 patients with a median follow-up of 25 months. For MACE in patients with negative findings on CCTA, there was a pooled negative likelihood ratio (LR) of 0.01 [95% confidence interval (CI) 0.00-0.08], a positive LR of 1.72 (95% CI 1.54-1.91), a sensitivity of 1.00 (95% CI 0.97-1.00), a specificity of 0.42 (95% CI 0.36-0.48) and a diagnostic odds ratio of 159.07 (95% CI 22.20-1,139.80). The weighted average annualized MACE rate for positive versus negative CCTA findings was 3.49 versus 0.21%. Stratifying by no CAD, nonobstructive CAD or obstructive CAD, there were incrementally increasing adverse events. Conclusions: Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.

Coronary Atherosclerosis: The Predictor of Cardiovascular Events

“…We know lipid-lowering therapy is effective, but to date we have not considered the fact that when atherosclerosis is not present, it is extremely unlikely that major adverse cardiovascular events will develop. CCT and the prognostic data collected in the meta-analysis of Jiang et al [10] show a very low number of events in the group without CAD. This means that there may have been a pharmacological overtreatment in this group.…”

“…In this issue of Cardiology we can read about the very precise and perceptive study carried out by Jiang et al [10 ]which provides a meta-analysis of prognostic studies performed with CCT. The authors assembled 18 studies that included 29,243 patients with a median follow-up of 25 months.…”

Chest pain: coronary CT in the ER

“…64 Moreover, overwhelming evidence supports the excellent mid-term and long-term prognosis after a negative cardiac CT examination, with an average annualized rate of major cardiac events as low as 0.21%. 65,66 This emphasizes a clinical value of cardiac CT for identification of patients with absence of coronary atherosclerotic plaques in whom no further additional testing and/or therapy is necessary or indicated.…”

Response to the Paper by Jiang et al. Entitled ‘Prognostic Value of Cardiac Computed Tomography Angiography in Patients with Suspected Coronary Artery Disease: A Meta-Analysis'

“…We read with great interest the article ‘Prognostic value of cardiac computed tomography angiography in patients with suspected coronary artery disease: a meta-analysis' by Jiang et al [1], which was recently published in Cardiology . Based on a complex meta-analysis of 18 published studies, the authors found that coronary computed tomographic angiography (CCTA) could serve as a prognostic tool, being able to stratify the risk of adverse cardiovascular events based on the severity of coronary artery stenosis.…”

“…Based on a complex meta-analysis of 18 published studies, the authors found that coronary computed tomographic angiography (CCTA) could serve as a prognostic tool, being able to stratify the risk of adverse cardiovascular events based on the severity of coronary artery stenosis. The study indicates an excellent prognosis for those with negative CCTA, while for the population with suspected coronary artery disease (CAD) and abnormal CCTA findings the authors found an incrementally increasing rate of major adverse cardiovascular events (MACE) with the increasing severity of coronary artery stenosis [1]. The study is well designed and leads to important conclusions.…”