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.
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.
Authors: E di Cesare; I Carbone; A Carriero; M Centonze; F De Cobelli; R De Rosa; P Di Renzi; A Esposito; R Faletti; R Fattori; M Francone; A Giovagnoni; L La Grutta; G Ligabue; L Lovato; R Marano; M Midiri; L Natale; A Romagnoli; V Russo; F Sardanelli; F Cademartiri Journal: Radiol Med Date: 2012-04-01 Impact factor: 3.469
Authors: Annika Schuhbäck; Mohamed Marwan; Sören Gauss; Gerd Muschiol; Dieter Ropers; Christian Schneider; Michael Lell; Johannes Rixe; Christian Hamm; Werner G Daniel; Stephan Achenbach Journal: Eur Radiol Date: 2012-03-27 Impact factor: 5.315
Authors: E Maffei; S Seitun; C Martini; A Aldrovandi; G Cervellin; C Tedeschi; A Guaricci; G Messalli; O Catalano; F Cademartiri Journal: Radiol Med Date: 2011-03-07 Impact factor: 3.469
Authors: Lene H Nielsen; John Markenvard; Jesper M Jensen; Hans Mickley; Kristian A Øvrehus; Bjarne L Nørgaard Journal: Int J Cardiovasc Imaging Date: 2010-11-02 Impact factor: 2.357
Authors: Edward Hulten; Marcio Sommer Bittencourt; Brian Ghoshhajra; Daniel O'Leary; Mitalee P Christman; Michael J Blaha; Quynh Truong; Kyle Nelson; Philip Montana; Michael Steigner; Frank Rybicki; Jon Hainer; Thomas J Brady; Udo Hoffmann; Marcelo F Di Carli; Khurram Nasir; Suhny Abbara; Ron Blankstein Journal: Atherosclerosis Date: 2014-01-08 Impact factor: 5.162