Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease.
OBJECTIVE
The purpose of this study was to assess the relationship between calcium scoring (CS) and multi-slice computed tomography coronary angiography (MSCTA) and to determine if MSCTA has an incremental prognostic value to CS.


RESULTS
In 432 patients (59% male, age 58 +/- 11 years) referred for cardiac evaluation owing to suspected coronary artery disease (CAD), CS and 64-slice MSCTA were performed. The following events were combined in a composite endpoint: all-cause mortality, non-fatal infarction, and unstable angina requiring revascularization. CS was 0 in 147 (34%) patients, CS 1-99 was present in 122 (28%), CS 100-399 in 75 (17%), CS 400-999 in 56 (13%), and CS > or = 1000 in 32 (7%). MSCTA was normal in 133 (31%) patients, MSCTA 30-50% stenosis was observed in 190 (44%), and MSCTA > or =50% stenosis in 109 (25%). During follow-up [median 670 days (25th-75th percentile: 418-895)], an event occurred in 21 patients (4.9%). After multivariate correction for CS, MSCTA > or = 50% stenosis, the number of diseased segments, obstructive segments, and non-calcified plaques were independent predictors with an incremental prognostic value to CS.


CONCLUSIONS
MSCTA provides additional information to CS regarding stenosis severity and plaque composition. This additional information was shown to translate into incremental prognostic value over CS.
van Werkhoven
Jacob M
JM
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Schuijf
Joanne D
JD
Gaemperli
Oliver
O
Jukema
J Wouter
JW
Kroft
Lucia J
LJ
Boersma
Eric
E
Pazhenkottil
Aju
A
Valenta
Ines
I
Pundziute
Gabija
G
de Roos
Albert
A
van der Wall
Ernst E
EE
Kaufmann
Philipp A
PA
Bax
Jeroen J
JJ
D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000401:mortality / Q000628:therapy; D002114:Calcinosis / Q000175:diagnosis*; D017023:Coronary Angiography / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000401:mortality / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000401:mortality