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J Am Coll Cardiol, 2007; 49:62-70, doi:10.1016/j.jacc.2006.07.070 (Published online 13 December 2006).
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

Prognostic Value of Multislice Computed Tomography Coronary Angiography in Patients With Known or Suspected Coronary Artery Disease

Gabija Pundziute, MD*,{dagger},1, Joanne D. Schuijf, MSc*,{ddagger},1, J. Wouter Jukema, MD, PhD*,{ddagger}, Eric Boersma, PhD§, Albert de Roos, MD, PhD||, Ernst E. van der Wall, MD, PhD*,{ddagger} and Jeroen J. Bax, MD, PhD*,*

* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
{dagger} Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania
{ddagger} Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
§ Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands
|| Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.

Manuscript received May 1, 2006; revised manuscript received July 24, 2006, accepted July 27, 2006.

* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).

OBJECTIVES: This study sought to determine the prognostic value of multislice computed tomography (MSCT) coronary angiography in patients with known or suspected coronary artery disease (CAD).

BACKGROUND: It is expected that MSCT will be used increasingly as an alternative imaging modality in the diagnosis of patients with suspected CAD. Data on the prognostic value of MSCT, however, are currently not available.

METHODS: A total of 100 patients (73 men, age 59 ± 12 years) who were referred for further cardiac evaluation due to suspicion of significant CAD underwent additional MSCT coronary angiography to evaluate the presence and severity of CAD. Patients were followed up for the occurrence of: 1) cardiac death, 2) nonfatal myocardial infarction, 3) unstable angina requiring hospitalization, and 4) revascularization.

RESULTS: Coronary plaques were detected in 80 (80%) patients. During a mean follow-up of 16 months, 33 events occurred in 26 patients. In patients with normal coronary arteries on MSCT, the first-year event rate was 0% versus 30% in patients with any evidence of CAD on MSCT. The observed event rate was highest in the presence of obstructive lesions (63%) and when obstructive lesions were located in the left main (LM)/left anterior descending (LAD) coronary arteries (77%). Nonetheless, an elevated event rate was also observed in patients with nonobstructive CAD (8%). In multivariate analysis, significant predictors of events were the presence of CAD, obstructive CAD, obstructive CAD in LM/LAD, number of segments with plaques, number of segments with obstructive plaques, and number of segments with mixed plaques.

CONCLUSIONS: Multislice computed tomography coronary angiography provides independent prognostic information over baseline clinical risk factors in patients with known and suspected CAD. An excellent prognosis was noted in patients with a normal MSCT.

Abbreviations and Acronyms
  CAD = coronary artery disease
  EBCT = electron beam computed tomography
  LAD = left anterior descending coronary artery
  LM = left main coronary artery
  MSCT = multislice computed tomography
  SPECT = single-photon emission computed tomography




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HeartHome page
W T Roberts, J J Bax, and L C Davies
Cardiac CT and CT coronary angiography: technology and application
Heart, June 1, 2008; 94(6): 781 - 792.
[Abstract] [Full Text] [PDF]


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CirculationHome page
R. Hachamovitch and M. F. Di Carli
Methods and Limitations of Assessing New Noninvasive Tests: Part II: Outcomes-Based Validation and Reliability Assessment of Noninvasive Testing
Circulation, May 27, 2008; 117(21): 2793 - 2801.
[Full Text] [PDF]


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J Am Coll Cardiol IntvHome page
G. Pundziute, J. D. Schuijf, J. W. Jukema, I. Decramer, G. Sarno, P. K. Vanhoenacker, J. H.C. Reiber, M. J. Schalij, W. Wijns, and J. J. Bax
Head-to-Head Comparison of Coronary Plaque Evaluation Between Multislice Computed Tomography and Intravascular Ultrasound Radiofrequency Data Analysis
J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 176 - 182.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol IntvHome page
S. Voros
Can Computed Tomography Angiography of the Coronary Arteries Characterize Atherosclerotic Plaque Composition?: Is the CAT (Scan) Out of the Bag?
J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 183 - 185.
[Full Text] [PDF]


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CirculationHome page
I. Gottlieb and J. A. C. Lima
Screening High-Risk Patients With Computed Tomography Angiography
Circulation, March 11, 2008; 117(10): 1318 - 1332.
[Full Text] [PDF]


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CirculationHome page
C. M. Kramer
All High-Risk Patients Should Not Be Screened With Computed Tomographic Angiography
Circulation, March 11, 2008; 117(10): 1333 - 1339.
[Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
J. A.C. Lima
Another Step Forward in CT Angiography.
J. Am. Coll. Cardiol. Img., March 1, 2008; 1(2): 187 - 189.
[Full Text] [PDF]


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Eur Heart JHome page
S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al.
Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology
Eur. Heart J., February 2, 2008; 29(4): 531 - 556.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
M. Williams, L. J. Shaw, P. Raggi, D. Morris, V. Vaccarino, S. T. Liu, S. R. Weinstein, T. P. Mosler, P. H. Tseng, F. R. Flores, et al.
Prognostic value of number and site of calcified coronary lesions compared with the total score.
J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 61 - 69.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
D. S. Berman, S. Achenbach, A. J. Taylor, G. Weigold, and M. Poon
Highlights of the Second Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography: Washington, DC, July 6 8, 2007
J. Am. Coll. Cardiol., December 11, 2007; 50(24): 2329 - 2335.
[Full Text] [PDF]


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J Am Coll CardiolHome page
J. K. Min, L. J. Shaw, R. B. Devereux, P. M. Okin, J. W. Weinsaft, D. J. Russo, N. J. Lippolis, D. S. Berman, and T. Q. Callister
Prognostic Value of Multidetector Coronary Computed Tomographic Angiography for Prediction of All-Cause Mortality
J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1161 - 1170.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. J. Mahmarian
Computed Tomography Coronary Angiography as an Anatomic Basis for Risk Stratification: Deja Vu or Something New?
J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1171 - 1173.
[Full Text] [PDF]


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J Am Coll CardiolHome page
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol., September 4, 2007; 50(10): 988 - 1003.
[Full Text] [PDF]


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Arch Intern MedHome page
M. Gilard, G. Le Gal, J.-C. Cornily, U. Vinsonneau, C. Joret, P.-Y. Pennec, J. Mansourati, and J. Boschat
Midterm Prognosis of Patients With Suspected Coronary Artery Disease and Normal Multislice Computed Tomographic Findings: A Prospective Management Outcome Study
Arch Intern Med, August 13, 2007; 167(15): 1686 - 1689.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
T. C. Gerber, B. Kantor, and P. Chareonthaitawee
Coronary computed tomographic angiography and exercise electrocardiography: a great match or unequal partners?
Eur. Heart J., August 1, 2007; 28(15): 1787 - 1789.
[Full Text] [PDF]


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J Am Coll CardiolHome page
J. D. Schuijf, G. Pundziute, and J. J. Bax
Reply
J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2071 - 2071.
[Full Text] [PDF]


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J Am Coll CardiolHome page
K. Nasir, M. J. Budoff, L. J. Shaw, and R. S. Blumenthal
Value of Multislice Computed Tomography Coronary Angiography in Suspected Coronary Artery Disease
J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2070 - 2071.
[Full Text] [PDF]



 
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