Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease.

Hadamitzky, M; Freissmuth, B; Meyer, T; Hein, F; Kastrati, A; Martinoff, S; Schömig, A; Hausleiter, J

doi:10.1016/j.jcmg.2008.11.015

2009

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Title:: Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease.
Document type:: Journal Article; Research Support, Non-U.S. Gov't
Author(s):: Hadamitzky, M; Freissmuth, B; Meyer, T; Hein, F; Kastrati, A; Martinoff, S; Schömig, A; Hausleiter, J
Abstract:: OBJECTIVES: We assessed the rate of cardiac events after detection or exclusion of obstructive coronary artery disease (CAD) by coronary computed tomography angiography (CCTA). BACKGROUND: Several studies have demonstrated a high diagnostic accuracy of CCTA for detection of obstructive CAD compared with invasive angiography, but data regarding the clinical prognostic value of CCTA are limited. METHODS: In all, 1,256 consecutive patients with suspected CAD undergoing 64-slice CCTA in our institution between October 2004 and September 2006 were observed prospectively for the occurrence of severe cardiac events (cardiac death, myocardial infarction, or unstable angina requiring hospitalization: primary study end point) and all cardiac events (additionally including revascularization >90 days after CCTA). The observed rate of all cardiac events was compared with the event rate predicted by the Framingham risk score. Obstructive CAD was defined as > or = 50% diameter stenosis in any coronary artery. RESULTS: During a median follow-up of 18 months (interquartile range 14 to 25 months), the overall rates of severe and all cardiac events were 0.6% and 1.8%, respectively. In 802 patients without obstructive CAD, there were 4 cardiac events, of which 1 was severe, whereas in 348 patients with obstructive CAD, there were 17 cardiac events, of which 5 were severe. The difference between the 2 groups was highly significant both for severe events (odds ratio: 17.3, 95% confidence interval: 3.6 to 82.5) and for all cardiac events (odds ratio: 16.1, 95% confidence interval: 7.2 to 36.0; both p < 0.001). The rate of all cardiac events in patients without obstructive CAD was significantly lower than predicted by the Framingham risk score (p = 0.01). CONCLUSIONS: In patients with suspected CAD, CCTA has a significant prognostic impact on the prediction of cardiac events for the subsequent 18 months. The exclusion of obstructive CAD by CCTA identifies a patient population with an event risk lower than predicted by conventional risk factors.
Journal title abbreviation:: JACC Cardiovasc Imaging
Year:: 2009
Journal volume:: 2
Journal issue:: 4
Pages contribution:: 404-11
Language:: eng
Fulltext / DOI:: doi:10.1016/j.jcmg.2008.11.015
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/19580721
Print-ISSN:: 1936-878X
TUM Institution:: I. Medizinische Klinik und Poliklinik (Kardiologie); Institut für Radiologie
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