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J Am Coll Cardiol, 2009; 53:623-632, doi:10.1016/j.jacc.2008.10.043
© 2009 by the American College of Cardiology Foundation
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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{dagger}{dagger}, Paul Stolzmann, MD#, Hatem Alkadhi, MD#, Ines Valenta, MD, Marcel P.M. Stokkel, MD, PhD{dagger}, Lucia J. Kroft, MD, PhD{ddagger}, Albert de Roos, MD, PhD{ddagger}, Gabija Pundziute, MD*, Arthur Scholte, MD*, Ernst E. van der Wall, MD, PhD*,§, Philipp A. Kaufmann, MD,{ddagger}{ddagger} and Jeroen J. Bax, MD, PhD, FACC*,*

* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
{dagger} Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
{ddagger} 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
{dagger}{dagger} Cardiovascular Center, Aalst, Belgium
{ddagger}{ddagger} 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

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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