Angiographic findings and clinical outcomes in asymptomatic patients with severe obstructive atherosclerosis on computed tomography angiography.
BACKGROUND
Cardiac computed tomography angiography is a relatively new imaging modality to detect coronary atherosclerosis.


OBJECTIVE
To explore the diagnostic value of CTA in assessing coronary artery disease among asymptomatic patients.


METHODS
In this retrospective single-centered analysis, 622 consecutive patients underwent CTA of coronary arteries between November 2004 and May 2006 at the Mor Institute for Cardiovascular Imaging in Bnei Brak, Israel. All patients were asymptomatic but had at least one risk factor for atherosclerotic CAD. The initial 244 patients were examined with the 16-slice Brilliance CT scanner (Philips, Cleveland, OH, U.S.A.), and in the remaining 378 patients the 64-slice scanner (GE Healthcare, The Netherlands) with dedicated cardiac reconstruction software and electrocardiography triggering was used. Scanning was performed in the cranio-caudal direction. Images reconstructed in different phases of the cardiac cycle using a retrospective ECG-gated reconstruction algorithm were transferred to a dedicated workstation for review by experienced CT radiologists and cardiologists.


RESULTS
Of 622 patients, 52 (8.4%) had severe obstructive atherosclerosis (suspected > or = 75% stenosis) according to CTA interpretation. Invasive coronary angiography was performed in 48 patients while 4 patients had no further procedure. A non-significant CAD (e.g., diameter stenosis < 70%) was identified in 6 of 48 patients (12%) by selective coronary angiography. Forty-two patients showed severe CAD with at least one lesion of 70% stenosis. Percutaneous coronary intervention was performed in 35 patients and coronary artery bypass grafting surgery in the other 4 patients. Angioplasty procedures were successful in all 35 patients and stents were utilized in all cases without complications. No further complications occurred among the study cohort undergoing either PCI or surgery. The 6 month survival rate in these patients was 100%.


CONCLUSIONS
Non-invasive coronary CTA appears to be a reliable technique, with reasonably high accuracy, to detect obstructive atherosclerosis in asymptomatic high risk patients for atherosclerotic CAD.
Kornowski
Ran
R
Institute of Interventional Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel. rkornowski@clalit.org.il
Bachar
Gil N
GN
Dvir
Danny
D
Fuchs
Shmuel
S
Atar
Eli
E
D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D003287:Contrast Media