Document Detail


A long-term prognostic value of coronary CT angiography in suspected coronary artery disease.
MedLine Citation:
PMID:  22789937     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to assess the long-term prognostic role of multidetector computed tomography coronary angiography (CTA) in patients with suspected coronary artery disease (CAD).
BACKGROUND: Use of CTA is increasing in patients with suspected CAD. Although there is a large body of data supporting the prognostic role of CTA for major adverse cardiac events in the intermediate term, its long-term prognostic role in patients with suspected CAD is not well studied.
METHODS: Between February 2005 and March 2008, 1,304 consecutive patients were prospectively studied with CTA for detecting the presence and assessing extent of CAD (disease extension and coronary plaque scores). Patients were classified according to the presence of normal coronaries and nonobstructive (<50%) and obstructive (>50%) coronary lesions. The composite rates of hard cardiac events (cardiac deaths and nonfatal myocardial infarctions) and all cardiac events (including late revascularization) were the endpoints of the study.
RESULTS: Seventy patients were excluded because their CTA data were uninterpretable. Of the remaining 1,234 patients, clinical follow-up (mean 52 ± 22 months) was obtained for 1,196 (97%). A total of 475 events were recorded, with 136 hard events (18 cardiac deaths and 118 nonfatal myocardial infarctions) and 123 late revascularizations. A total of 216 patients with early elective revascularizations were excluded from the survival analysis. Significant independent predictors of events in multivariate analysis were multivessel disease and left main CAD. Cumulative event-free survival was 100% for hard and all events in patients with normal coronary arteries, 88% for hard events and 72% for all events in patients with nonobstructive CAD, and 54% for hard events and 31% for all events in patients with obstructive CAD. Multivessel CAD was associated with a higher rate of hard cardiac events.
CONCLUSIONS: CTA provides prognostic information in patients with suspected CAD and unknown cardiac disease, showing excellent long-term prognosis when there is no evidence of atherosclerosis and allowing risk stratification when CAD is present.
Authors:
Daniele Andreini; Gianluca Pontone; Saima Mushtaq; Antonio L Bartorelli; Erika Bertella; Laura Antonioli; Alberto Formenti; Sarah Cortinovis; Fabrizio Veglia; Andrea Annoni; Piergiuseppe Agostoni; Piero Montorsi; Giovanni Ballerini; Cesare Fiorentini; Mauro Pepi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  5     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-13     Completed Date:  2012-12-03     Revised Date:  2013-02-27    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  690-701     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Centro Cardiologico Monzino, IRCCS, Milan, Italy. daniele.andreini@ccfm.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography / methods*
Coronary Artery Disease / complications,  mortality,  radiography*
Coronary Stenosis / complications,  mortality,  radiography*
Disease-Free Survival
Female
Humans
Italy
Kaplan-Meier Estimate
Male
Middle Aged
Multidetector Computed Tomography*
Multivariate Analysis
Myocardial Infarction / etiology
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2013 Jan;6(1):128-9   [PMID:  23328573 ]
JACC Cardiovasc Imaging. 2013 Jan;6(1):127-8   [PMID:  23328572 ]

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