Prognostic Value of Coronary Computed Tomographic Angiography Among 1,125 Consecutive Military Health Care Beneficiaries Without Known Coronary Artery Disease

Abstract

We sought to assess the prognostic value of coronary computed tomography angiography (CCTA) among military health care system beneficiaries. We identified 1,125 consecutive symptomatic patients without known coronary artery disease (CAD) referred for 64-slice CCTA (2006-2010) at a single center. CAD was assessed as none, < 50%, or > or = 50% (obstructive) coronary stenosis. A combined endpoint of major adverse events (death, myocardial infarction [MI], coronary revascularization > 90 days after CCTA) was assessed by Kaplan-Meier and Cox proportional hazards. The mean age was 50 +/- 12 years, 59% were male, and 617 (55%) had no CAD, 411 (37%) nonobstructive CAD, and 97 (9%) obstructive CAD on CCTA. During 2.0 +/- 1.1-year follow-up, there were 6 deaths, 3 MIs, and 6 revascularizations. There was 1 event in the no-CAD group (0.08%/year), 4 events in the nonobstructive group (0.5%/year), and 9 events in patients with obstructive CAD (4.5%/year) (p < 0.001). Patients with obstructive CAD had significantly increased combined adverse events. Increasing angina typicality and risk factors (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.05-1.46; p = 0.01) and obstructive CAD (HR 12.1, 95% CI 3.99-36.9; p < 0.001) were independently predictive of events. Absence of CAD was associated with very low event rates, providing military health care system patients and providers confidence in regards to cardiovascular risk, future deployments, and occupational assignments.

The role of cardiovascular CT in occupational health assessment for coronary heart disease: An expert consensus document from the Society of Cardiovascular Computed Tomography (SCCT)

“…Coronary CTA has been studied in the military population, demonstrating its accuracy in ruling out occupationally significant CAD, 153 identifying anomalous coronary artery origins, 154 and informing cardiovascular prognosis. 155 Coronary CTA also demonstrated lower rates of subsequent evaluations for chest pain and repeat testing, 156 and an increase in the use of preventive cardiovascular medications, 157 whilst reducing the radiation exposure to service personnel. 158 A recent meta-analysis demonstrated a CCTA can exclude anatomically defined coronary artery disease in nearly all patients regardless of their pre-test probability.…”

Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

“… 6 Prior CCTA studies have evaluated all-cause mortality, non-fatal myocardial infarction (MI), and late revascularization only. 7 There are no data on the incidence of ischemic stroke based upon an individual’s burden of coronary atherosclerosis.…”