Document Detail

Clinical effectiveness of coronary computed tomographic angiography in the triage of patients to cardiac catheterization and revascularization after inconclusive stress testing: results of a 2-year prospective trial.
MedLine Citation:
PMID:  19626385     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Management of patients with suspected coronary artery disease (CAD) and inconclusive stress imaging test findings may result in invasive coronary angiography (ICA). Coronary computed tomographic angiography (CCTA) may be useful in defining the risk of CAD and adverse outcomes in this patient population, as well as in reducing the need for ICA. METHODS: We prospectively enrolled 199 sequential patients referred by cardiologists for CCTA after either inconclusive or nondiagnostic stress imaging tests. Before CCTA, physicians identified a "planned catheterization" group of patients who would undergo invasive angiography if CCTA were not available. After CCTA testing, patients were followed for >or=2 years. We established the added diagnostic value of the CCTA and its prognostic power in prediction of intermediate-term follow-up events in this patient population as compared to available historical and clinical predictors of CAD, stress ECG, and stress imaging test results using a multivariable Cox proportional hazards survival analysis. RESULTS: Both observed data and results of the multivariable model for the prediction of obstructive CAD (>50% stenosis), or major cardiac events (death MI or revascularization), demonstrated that clinical, stress ECG, and imaging results were weakly predictive, whereas CCTA was found to be a strong independent and incremental predictor of the absence of either significant CAD or MACE in this population. None of the 93 patients with normal CCTA scans had MACE events, whereas 18 patients with evidence of CAD on the CCTA results underwent revascularization. Overall, physicians planned ICA in 125 patients (63.0%); after CCTA, ICA was performed in only 32 (16.0%) cases over 2 years. In this population with no other highly effective noninvasive clinical tools for diagnostic and prognostic estimation, the overall negative predictive value of CCTA for either CAD > 50% or MACE for 2 years was 99%. CONCLUSION: Observations from this prospective study demonstrate the significant added diagnostic value and prognostic potential of CCTA in patients with suspected CAD and either inconclusive or nondiagnostic stress test results in real-world settings. Normal CCTA results are associated with excellent intermediate-term prognosis in this clinical subset, and invasive angiography can be safely avoided in the majority of these patients when the results of CCTA are available.
Aiden Abidov; Michael J Gallagher; Kavitha M Chinnaiyan; Laxmi S Mehta; James H Wegner; Gilbert L Raff
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-07-22
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  16     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2009 Sep-Oct
Date Detail:
Created Date:  2009-09-18     Completed Date:  2009-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  701-13     Citation Subset:  IM    
Sarver Heart Center, University of Arizona, Tucson, AZ 85721, USA.
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MeSH Terms
Catheter Ablation / utilization*
Coronary Angiography / utilization*
Coronary Artery Disease / mortality*,  radiography*,  surgery
Exercise Test
Middle Aged
Myocardial Revascularization / utilization*
Outcome Assessment (Health Care) / methods
Preoperative Care / statistics & numerical data
Prospective Studies
Reproducibility of Results
Risk Assessment / methods
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
Tomography, X-Ray Computed / utilization*
Triage / utilization*
United States / epidemiology
Comment In:
J Nucl Cardiol. 2009 Sep-Oct;16(5):683-5   [PMID:  19641977 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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