title: Prognostic utility of 64-slice computed tomography in patients with suspected but no documented coronary artery disease.
abstract: OBJECTIVE
  Although multislice computed tomography (MSCT) detects obstructive coronary artery disease (CAD) with high diagnostic accuracy, there is a paucity of long-term prognostic data. We sought to assess the incremental prognostic value of 64-slice CT in patients with suspected but no documented CAD.
  
  
  RESULTS
  Coronary MSCT was performed on 227 individuals (61% men, mean age 54 +/- 12 years, 63% with intermediate pre-test probability) without documented CAD, referred for coronary evaluation. Coronary artery disease by MSCT was categorized as follows: none or mild CAD (<50%, n = 172), > or =50% in one vessel (n = 23), two vessels [or in the proximal left anterior descending (LAD), n = 12], and three vessels (or in two vessels including the proximal LAD or left main, n = 20). Baseline risk factors, length of follow-up, and major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and coronary revascularization were recorded. Over a mean follow-up of 2.3 +/- 0.8 years, there were 18 MACE [including four hard events (one cardiac death and three MIs)]. Also, patients with one or more vessel obstructive CAD had increased hard events compared with those with less than one-vessel disease (log-rank statistic P-value 0.01). One or more vessel obstructive CAD was a significant predictor of MACE on univariable and multivariable Cox proportional survival analysis [hazard ratios 29.1 (6.7-126.6) and 9.82 (3.58-27.01), respectively, both P < 0.0001]. In 172 patients, with no or mild CAD, there was 99% freedom from MACE during follow-up.
  
  
  CONCLUSIONS
  Multislice computed tomography-classified extent of CAD provides incremental prognostic information in patients with suspected but no documented CAD.
authors.affiliation: Department of Cardiovascular Medicine, Desk F 15, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Carrigan
authors.forename: Deepu
authors.initials: D
authors.lastname: Nair
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.forename: Ronan J
authors.initials: RJ
authors.lastname: Curtin
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popovic
authors.forename: Sandra
authors.initials: S
authors.lastname: Halliburton
authors.forename: Stacie
authors.initials: S
authors.lastname: Kuzmiak
authors.forename: Richard D
authors.initials: RD
authors.lastname: White
authors.forename: Scott D
authors.initials: SD
authors.lastname: Flamm
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods