The prognostic value of multidetector coronary CT angiography for the prediction of major adverse cardiovascular events: a multicenter observational cohort study

Abstract

To assess the prognostic value of coronary artery stenosis identification by coronary computed tomographic angiography (CCTA) for the prediction of major adverse cardiac events (MACE) in a multicenter prospective cohort study. We performed a prospective multicenter observational cohort study of symptomatic patients with suspected or known coronary artery disease (CAD) (n = 172; 57% male) undergoing CCTA in accordance to ACC/AHA Appropriateness Criteria from 4 sites in and around Paris, France, and followed for a mean duration of 22.0 +/- 4.5 months (interquartile range 18-26 months). Coronary arteries by CCTA were interpreted by physicians blinded to the patient characteristics for the presence or absence obstructive (>or=70% luminal diameter stenosis), as well as for plaque composition categorized as non-calcified, calcified or "mixed." MACE was defined as death, non-fatal myocardial infarction, unstable angina or target vessel revascularization. MACE event rates were compared between patients with or without obstructive plaque and with differing plaque compositions. MACE event rates were significantly higher in patients with obstructive coronary artery stenosis by CCTA compared to those without (61.1% vs. 3.9%, P < 0.01). In patients with obstructive stenosis, mixed (83.3% vs. 25.3%, P < 0.01) and calcified (94.4% vs. 50.7%, P < 0.01) plaque presence was significantly higher than in patients without obstructive stenosis, with no differences in prevalence of non-calcified plaque (27.8% vs. 20.8%, P = NS). For MACE, the negative predictive value of no observed coronary artery plaque was 100% in the follow-up period. In this prospective multicenter study of symptomatic patients with suspected or known CAD undergoing CCTAs interpreted by imagers blinded to patient characteristics, CCTA presence of plaque severity and composition successfully identifies patients at risk for incident MACE events. Importantly, a negative CCTA portends an extremely low risk for incidence MACE.

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

“…As reported conventionally, 10,11) correct assessment of coronary lesions in patients with severe coronary calcifications (high CAC scores) is difficult. A report of the American College of Cardiology Foundation, along with key specialty and subspecialty societies, 12) recommended that when the CAC score was used as a prior test for coronary CT angiography, the result of a CAC score ≤ 400 was "appropriate" for using coronary CT angiography.…”

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

“…53 Min et al in their CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) trial evaluated a consecutive cohort of 24,775 patients with suspected CAD who were enrolled at 12 international centers 54 Their results along with others showed that a significant increased risk in adverse cardiac events was observed in patients with CCTA-identified obstructive CAD but with much lower event rates in patients with normal CCTA findings. [54][55]56,57 These results indicate that CCTA could serve as an independent predictor of major adverse cardiac events in patients with suspected CAD, although more studies based on large cohort with long-term follow-up are needed.…”

Koroner Arter Hastalığı

“…Min ve ark. [38], çok merkezli yaptıkları bir çalışma ile tıkayıcı KAH varlığının majör kardiyak olayların güçlü bir göstergesi olduğu-nu ortaya koymuşlardır. Abdullah ve ark.…”