CLINICAL RESEARCH: CARDIAC IMAGING
Prognostic Value of Multislice Computed Tomography and Gated Single-Photon Emission Computed Tomography in Patients With Suspected Coronary Artery Disease
Jacob M. van Werkhoven, MSc*, ,
Joanne D. Schuijf, PhD*,
Oliver Gaemperli, MD||,¶,
J. Wouter Jukema, MD, PhD*,,
Eric Boersma, MSc, PhD**,
William Wijns, MD, PhD ,
Paul Stolzmann, MD#,
Hatem Alkadhi, MD#,
Ines Valenta, MD¶,
Marcel P.M. Stokkel, MD, PhD,
Lucia J. Kroft, MD, PhD ,
Albert de Roos, MD, PhD,
Gabija Pundziute, MD*,
Arthur Scholte, MD*,
Ernst E. van der Wall, MD, PhD*,,
Philipp A. Kaufmann, MD¶, and
Jeroen J. Bax, MD, PhD, FACC*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
|| Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
¶ Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
# Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
** Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
Cardiovascular Center, Aalst, Belgium
Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland
Manuscript received September 24, 2008;
revised manuscript received October 30, 2008,
accepted October 30, 2008.
* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands (Email: j.j.bax{at}lumc.nl).
Objectives: This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD).
Background: Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear.
Methods: In 541 patients (59% male, age 59 ± 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization.
Results: In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT  50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [SSS]: 4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT <50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT 50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS 4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005).
Conclusions: MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification.
Key Words: imaging • atherosclerosis • perfusion • prognosis
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CS = coronary artery calcium score | | ECG = electrocardiogram | | MPI = myocardial perfusion imaging | | MSCT = multislice computed tomography coronary angiography | | SPECT = single-photon emission computed tomography | | SSS = summed stress score |
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