Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease.
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.
van Werkhoven
Jacob M
JM
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
Schuijf
Joanne D
JD
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Gaemperli
Oliver
O
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
Jukema
J Wouter
JW
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
Boersma
Eric
E
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Wijns
William
W
Cardiovascular Center, Aalst, Belgium.
Stolzmann
Paul
P
Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
Alkadhi
Hatem
H
Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
Valenta
Ines
I
Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
Stokkel
Marcel P M
MPM
Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.
Kroft
Lucia J
LJ
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
de Roos
Albert
A
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Pundziute
Gabija
G
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Scholte
Arthur
A
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
van der Wall
Ernst E
EE
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
Kaufmann
Philipp A
PA
Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
Bax
Jeroen J
JJ
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.j.bax@lumc.nl.
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