Prognostic value of computed tomography coronary angiography in patients with suspected coronary artery disease: a 24-month follow-up study

Abstract

The aim of this study was to determine the predictive value of 64-slice computed tomography coronary angiography (CTCA) for major cardiac events in patients with suspected coronary artery disease (CAD). A total of 187 consecutive patients (119 men, age 62.5 +/- 10.5 years) without known heart disease underwent single-source 64-slice CTCA (Somatom Sensation 64, Siemens) for clinical suspicion of CAD. Patients underwent follow-up for the occurrence of cardiac death, nonfatal myocardial infarction, unstable angina and cardiac revascularization. In total, 2,822 coronary segments were assessed. Forty-two segments (1.5%) were not assessable because of insufficient image quality. Overall, CTCA revealed absence of CAD in 65 (34.7%) patients, nonobstructive CAD (coronary plaque < or =50%) in 87 (46.5%) patients and obstructive CAD (>50%) in 35 (18.8%) patients. A total of 20 major cardiac events (3 myocardial infarctions, 16 cardiac revascularizations, 1 unstable angina) occurred during a mean follow-up of 24 months. One noncardiac death occurred. Seventeen events occurred in the group of patients with obstructive CAD and three events occurred in the group of nonobstructive CAD. The event rate was 0% among patients with normal coronary arteries at CTCA. CTCA has a 100% negative predictive value for major cardiac events at 24-month follow-up in patients with normal coronary arteries.

Prognostic Value of Nonobstructive and Obstructive Coronary Artery Disease Detected by Coronary Computed Tomography Angiography to Identify Cardiovascular Events

“…Various other studies have also evaluated the prognostic value of coronary CTA for identifying a combination of cardiovascular death, MI, and revascularizations across different clinical scenarios. [27][28][29][30][31][32] This has the advantage of focusing on outcomes that are associated with the actual disease process detected by coronary CTA. However, findings from these studies may be driven by revascularizations triggered by the coronary CTA findings.…”

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

“…The abstract or full text of the 59 remaining studies was evaluated to determine eligibility. Forty studies from the literature search were excluded after further review and 18 [2,3,4,5,6,7,8,9,10,11,12,14,15,16,17,18,19,20] were identified for inclusion (fig. 1).…”

“…As a result, modern CCTA has been adopted clinically for the assessment of symptomatic patients with suspected CAD. In addition to its potential diagnostic value, growing evidence indicates that the presence and severity of CAD as defined by CCTA is also associated with the risk for future cardiac events [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. However, evidence from available individual studies is limited by the large uncertainty that exists with regard to their individual risks estimates, mostly as a result of the limited number of outcomes but also due to differences among the populations investigated and the outcomes reported such as death, myocardial infarction (MI) and coronary revascularization.…”

Infarct characterization using CT

“…A plenty of studies demonstrated the high diagnostic accuracy of CCT (Table 2) in the diagnostic workup of patients with suspected CAD (3)(4)(5)8,11,(79)(80)(81)(82)(83) and low to intermediate risk of CAD (6,84). CCT was also validated by several outcome studies that investigated risk stratification and prognostic value in registry data (85)(86)(87). Nonetheless, CCT may also provide functional information including regional heart function …”

“…Authors retrospectively evaluated fifty-three patients who underwent stress dynamic CTP and either SPECT (n = 25) or CMR (n = 28) and found that for detecting the abnormal perfused myocardium, sensitivity and specificity were 80% (95% CI, 71-90) and 86% (95% CI, 76-91) in SPECT (cut-off MBF, 1.23), and 82% (95% CI, 76-88) and 87% (95% CI, [80][81][82][83][84][85][86][87][88][89][90][91][92] in CMR (cut-off MBF, 1.25) (69).…”