CLINICAL RESEARCH: CARDIAC IMAGING
Prognostic Value of Multislice Computed Tomography Coronary Angiography in Patients With Known or Suspected Coronary Artery Disease
Gabija Pundziute, MD*, ,1,
Joanne D. Schuijf, MSc*, ,1,
J. Wouter Jukema, MD, PhD*,,
Eric Boersma, PhD ,
Albert de Roos, MD, PhD||,
Ernst E. van der Wall, MD, PhD*, and
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania
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.
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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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