Marc Dewey1, Carlos E Rochitte2, Mohammad R Ostovaneh3, Marcus Y Chen4, Richard T George3, Hiroyuki Niinuma5, Kakuya Kitagawa6, Roger Laham7, Klaus Kofoed8, Cesar Nomura9, Hajime Sakuma6, Kunihiro Yoshioka10, Vishal C Mehra3, Masahiro Jinzaki11, Sachio Kuribayashi11, Michael Laule12, Narinder Paul13, Arthur J Scholte14, Rodrigo Cerci3, John Hoe15, Swee Yaw Tan16, Frank J Rybicki17, Matthew B Matheson18, Andrea L Vavere3, Andrew E Arai4, Julie M Miller3, Christopher Cox18, Jeffrey Brinker3, Melvin E Clouse7, Marcelo Di Carli19, João A C Lima3, Armin Arbab-Zadeh20. 1. Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany. 2. InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil. 3. Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA. 4. Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA. 5. Memorial Heart Center, Iwate Medical University, Morioka, Japan; Department of Radiology, St. Luke's International Hospital, Tokyo, Japan. 6. Department of Radiology, Mie University Hospital, Tsu, Japan. 7. Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass, USA. 8. Department of Cardiology, Rigs Hospitalet, University of Copenhagen, Denmark. 9. Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil. 10. Memorial Heart Center, Iwate Medical University, Morioka, Japan. 11. Keio University School of Medicine, Tokyo, Japan. 12. Department of Medicine/Cardiology, Charité Medical School-Humboldt, Berlin, Germany. 13. Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada. 14. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 15. Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore. 16. Department of Cardiology, National Heart Centre, Singapore. 17. Department of Radiology, University of Cincinnati, Cincinnati, OH, USA. 18. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 19. Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, MA, USA. 20. Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287, USA. Electronic address: azadeh1@jhmi.edu.
Abstract
BACKGROUND: Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). METHODS: At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). RESULTS: Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). CONCLUSIONS: Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. CLINICAL TRIAL REGISTRATION: NCT00934037.
BACKGROUND: Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). METHODS: At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). RESULTS: Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). CONCLUSIONS: Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. CLINICAL TRIAL REGISTRATION: NCT00934037.
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