title: Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease.
abstract: OBJECTIVE
  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 > or =50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [SSS]: > or =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 > or =50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS > or =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.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: van Werkhoven
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.affiliation: Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.affiliation: Cardiovascular Center, Aalst, Belgium.
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Ines
authors.initials: I
authors.lastname: Valenta
authors.affiliation: Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Marcel P M
authors.initials: MPM
authors.lastname: Stokkel
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Lucia J
authors.initials: LJ
authors.lastname: Kroft
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Gabija
authors.initials: G
authors.lastname: Pundziute
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Arthur
authors.initials: A
authors.lastname: Scholte
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.j.bax@lumc.nl.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed