OBJECTIVES: The aim of the study was to perform a comparison of the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). BACKGROUND: CAD is a major cause of mortality and morbidity, and its management consumes a large proportion of the health care budget. Therefore, identification of patients at high risk of adverse events is crucial. Despite its limited accuracy, ex-ECG is the most commonly used noninvasive test in CAD evaluation. CTA was recently introduced as alternative test. METHODS: We enrolled 681 patients (age 61.3 ± 10.4 years, 461 men) with atypical or typical angina and no history of CAD. All patients underwent ex-ECG and CTA and were followed for 44 ±12 months. The endpoints were all cardiac events, defined as nonfatal myocardial infarction, cardiac death, and revascularization, and hard cardiac events, defined as all cardiac events excluding revascularization. RESULTS: ex-ECG and CTA were rated as positive in 419 (61%) and 274 (40%) of 681 patients, respectively. In univariate analysis, both ex-ECG and CTA were predictors of all cardiac events (hazard ratio [HR]: 2.09, 95% confidence interval [CI]: 1.5 to 2.8; p < 0.0001 and HR: 21.1, 95% CI: 14.6 to 30.5; p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% CI: 1.1 to 3.2; p = 0.02 and HR: 6.8, 95% CI: 3.9 to 11.0; p < 0.0001, respectively), whereas in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Stratifying our population by ex-ECG and CTA findings, Kaplan-Meier curves showed that ex-ECG provides only a further risk stratification in the subset of patients with positive findings on CTA and a low to intermediate likelihood of CAD. Moreover, positive findings on CTA identify a shorter event-free period, regardless the ex-ECG findings for both all cardiac events and hard cardiac events, respectively. CONCLUSIONS: CTA may have a higher prognostic value compared with ex-ECG in patients with suspected CAD, mainly in those with a low to intermediate pre-test likelihood of CAD.
OBJECTIVES: The aim of the study was to perform a comparison of the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). BACKGROUND: CAD is a major cause of mortality and morbidity, and its management consumes a large proportion of the health care budget. Therefore, identification of patients at high risk of adverse events is crucial. Despite its limited accuracy, ex-ECG is the most commonly used noninvasive test in CAD evaluation. CTA was recently introduced as alternative test. METHODS: We enrolled 681 patients (age 61.3 ± 10.4 years, 461 men) with atypical or typical angina and no history of CAD. All patients underwent ex-ECG and CTA and were followed for 44 ±12 months. The endpoints were all cardiac events, defined as nonfatal myocardial infarction, cardiac death, and revascularization, and hard cardiac events, defined as all cardiac events excluding revascularization. RESULTS:ex-ECG and CTA were rated as positive in 419 (61%) and 274 (40%) of 681 patients, respectively. In univariate analysis, both ex-ECG and CTA were predictors of all cardiac events (hazard ratio [HR]: 2.09, 95% confidence interval [CI]: 1.5 to 2.8; p < 0.0001 and HR: 21.1, 95% CI: 14.6 to 30.5; p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% CI: 1.1 to 3.2; p = 0.02 and HR: 6.8, 95% CI: 3.9 to 11.0; p < 0.0001, respectively), whereas in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Stratifying our population by ex-ECG and CTA findings, Kaplan-Meier curves showed that ex-ECG provides only a further risk stratification in the subset of patients with positive findings on CTA and a low to intermediate likelihood of CAD. Moreover, positive findings on CTA identify a shorter event-free period, regardless the ex-ECG findings for both all cardiac events and hard cardiac events, respectively. CONCLUSIONS: CTA may have a higher prognostic value compared with ex-ECG in patients with suspected CAD, mainly in those with a low to intermediate pre-test likelihood of CAD.
Authors: Gianluca Pontone; Daniele Andreini; Erika Bertella; Monica Loguercio; Marco Guglielmo; Andrea Baggiano; Giovanni Donato Aquaro; Saima Mushtaq; Sara Salerni; Paola Gripari; Carmen Rossi; Chiara Segurini; Edoardo Conte; Virginia Beltrama; Marta Giovannardi; Fabrizio Veglia; Andrea Igoren Guaricci; Antonio L Bartorelli; Piergiuseppe Agostoni; Mauro Pepi; Pier Giorgio Masci Journal: Eur Radiol Date: 2015-10-29 Impact factor: 5.315
Authors: Michael K Cheezum; Prem Srinivas Subramaniyam; Marcio S Bittencourt; Edward A Hulten; Brian B Ghoshhajra; Nishant R Shah; Daniel E Forman; Jon Hainer; Marcia Leavitt; Ram Padmanabhan; Hicham Skali; Sharmila Dorbala; Udo Hoffmann; Suhny Abbara; Marcelo F Di Carli; Henry Gewirtz; Ron Blankstein Journal: Eur Heart J Cardiovasc Imaging Date: 2015-04-20 Impact factor: 6.875
Authors: Adriane E Napp; Robert Haase; Michael Laule; Georg M Schuetz; Matthias Rief; Henryk Dreger; Gudrun Feuchtner; Guy Friedrich; Miloslav Špaček; Vojtěch Suchánek; Klaus Fuglsang Kofoed; Thomas Engstroem; Stephen Schroeder; Tanja Drosch; Matthias Gutberlet; Michael Woinke; Pál Maurovich-Horvat; Béla Merkely; Patrick Donnelly; Peter Ball; Jonathan D Dodd; Martin Quinn; Luca Saba; Maurizio Porcu; Marco Francone; Massimo Mancone; Andrejs Erglis; Ligita Zvaigzne; Antanas Jankauskas; Gintare Sakalyte; Tomasz Harań; Malgorzata Ilnicka-Suckiel; Nuno Bettencourt; Vasco Gama-Ribeiro; Sebastian Condrea; Imre Benedek; Nada Čemerlić Adjić; Oto Adjić; José Rodriguez-Palomares; Bruno Garcia Del Blanco; Giles Roditi; Colin Berry; Gershan Davis; Erica Thwaite; Juhani Knuuti; Mikko Pietilä; Cezary Kępka; Mariusz Kruk; Radosav Vidakovic; Aleksandar N Neskovic; Ignacio Díez; Iñigo Lecumberri; Jacob Geleijns; Christine Kubiak; Anke Strenge-Hesse; The-Hoang Do; Felix Frömel; Iñaki Gutiérrez-Ibarluzea; Gaizka Benguria-Arrate; Hans Keiding; Christoph Katzer; Jacqueline Müller-Nordhorn; Nina Rieckmann; Mario Walther; Peter Schlattmann; Marc Dewey Journal: Eur Radiol Date: 2016-11-18 Impact factor: 5.315
Authors: Giuseppe Muscogiuri; Marly Van Assen; Christian Tesche; Carlo N De Cecco; Mattia Chiesa; Stefano Scafuri; Marco Guglielmo; Andrea Baggiano; Laura Fusini; Andrea I Guaricci; Mark G Rabbat; Gianluca Pontone Journal: Biomed Res Int Date: 2020-12-16 Impact factor: 3.411