Prognostic value of coronary CT angiography on long-term follow-up of 6.9 years

Abstract

Long term follow-up of coronary CT angiography (CCTA) is scarce. The aim of the present study was to assess the prognostic value of CCTA over a follow-up period of more than 6 years. 218 Patients were included undergoing 64-slice CCTA. Images were analysed with regard to the presence of nonobstructive (<50 %) or obstructive (50 % stenosis) coronary artery disease (CAD). Major adverse cardiovascular events (MACE) were defined as death, nonfatal myocardial infarction or urgent coronary revascularization. CCTA revealed normal coronaries in 49, nonobstructive lesions in 94, and obstructive CAD in 75 patients. During a median follow-up period of 6.9 years, MACE occurred in 45 patients (21 %). Annual MACE rates were 0.3, 2.7, and 6.0 % (p = 0.001), for patients with normal CCTA, nonobstructive, and obstructive CAD, respectively. Multivariate Cox regression analysis identified the number of segments with plaques [hazard ratio (HR) 1.18, p = 0.002] as well as the presence of obstructive lesions (HR 2.28, p = 0.036) as independent predictors of MACE. The present study extends the predictive value of CCTA over more than 6 years. Patients with normal coronary arteries of CCTA continue to have an excellent cardiac prognosis, while outcome is progressively worse in patients with nonobstructive and obstructive CAD.

Coronary CT Angiography in Coronary Artery Disease: from Diagnosis to Prevention

“…50 Their results are in line with these reports highlighting the excellent longterm prognosis in normal CCTA with a very low likelihood for cardiac events. Two systematic reviews/meta-analyses on the prognostic value of CCTA also confirmed these findings with low cumulative major adverse cardiac events in patients with normal CCTA findings, but much higher event rates in patients with abnormal CCTA showing obstructive CAD.…”

Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging

“…Another study examined the prognostic value of CTA in 218 Patients over a follow-up period of more than 6 years. [70] Images were analyzed for non-obstructive (\50 %) or obstructive (50 % stenosis) CAD, and major adverse cardiovascular events (MACE) were identified, including death, nonfatal myocardial infarction or urgent coronary revascularization. CTA revealed normal coronaries in 49, non-obstructive lesions in 94, and obstructive CAD in 75 patients.…”

On the use of computed tomography in cardiac imaging

“…The maximum follow-up time of 7.5 years was unusually long in this context, although the median follow up time of 3.1 years was more in line with earlier studies. Only three patients (0.2%) were lost to follow-up, due to not having a Swedish personal identity number, as compared to approximately 5-15% in several other studies (25,27,28).…”

“…All exams in patients with known CAD or other cardiac disease were excluded, as were all exams with suboptimal image quality. Thus, the patient selection process was similar to several other studies with similar objectives (24)(25)(26)(27)(95)(96)(97).…”

“…However, CCTA is currently not recommended in cases with a high PTP, as this patient category may have more to gain from conventional ICA (21)(22)(23). Despite several studies, the long-term prognostic value is not entirely clear, although a normal result on CCTA seems to indicate a good prognosis (24)(25)(26)(27)(28).…”