Jacob M van Werkhoven1, Joanne D Schuijf2, Oliver Gaemperli3, J Wouter Jukema1, Eric Boersma4, William Wijns5, Paul Stolzmann6, Hatem Alkadhi6, Ines Valenta7, Marcel P M Stokkel8, Lucia J Kroft9, Albert de Roos9, Gabija Pundziute2, Arthur Scholte2, Ernst E van der Wall1, Philipp A Kaufmann10, Jeroen J Bax11. 1. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands. 2. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. 4. Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands. 5. Cardiovascular Center, Aalst, Belgium. 6. Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland. 7. Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. 8. Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands. 9. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 10. Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland. 11. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.j.bax@lumc.nl.
Abstract
OBJECTIVES: This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD). BACKGROUND: Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear. METHODS: In 541 patients (59% male, age 59 +/- 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization. RESULTS: In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT > or =50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [SSS]: > or =4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT <50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT > or =50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS > or =4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005). CONCLUSIONS: MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification.
OBJECTIVES: This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD). BACKGROUND: Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear. METHODS: In 541 patients (59% male, age 59 +/- 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization. RESULTS: In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT > or =50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [SSS]: > or =4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT <50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT > or =50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS > or =4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005). CONCLUSIONS: MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification.
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