Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood.
OBJECTIVE
To assess whether multislice computed tomography coronary angiography (MSCTA) may be useful for risk stratification of patients with suspected coronary artery disease (CAD) at intermediate pretest likelihood according to Diamond and Forrester.


METHODS
MSCTA images were evaluated for the presence of significant CAD in 316 patients with suspected CAD (60% male, average (SD) age 57 (11) years) and an intermediate pretest likelihood according to Diamond and Forrester. Patients were followed up to determine the occurrence of an event.


METHODS
A combined end point of all-cause mortality, non-fatal infarction and unstable angina requiring revascularisation.


RESULTS
Significant CAD was seen in 89 patients (28%), whereas normal MSCTA or non-significant CAD was seen in the remaining 227 (72%) patients. During follow-up (median 621 days (25-75th centile 408-835) an event occurred in 13 patients (4.8%). The annualised event rate was 0.8% in patients with normal MSCT, 2.2% in patients with non-significant CAD and 6.5% in patients with significant CAD. Moreover, MSCTA remained a significant predictor (p<0.05) of events after multivariate correction (hazard ratio = 3.460 (95% CI 1.142 to 10.480).


CONCLUSIONS
The results suggest that in patients with an intermediate pretest likelihood, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasise the usefulness of non-invasive imaging with MSCTA in this patient population.
van Werkhoven
J M
JM
Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. j.m.van_werkhoven@lumc.nl
Gaemperli
O
O
Schuijf
J D
JD
Jukema
J W
JW
Kroft
L J
LJ
Leschka
S
S
Alkadhi
H
H
Valenta
I
I
Pundziute
G
G
de Roos
A
A
van der Wall
E E
EE
Kaufmann
P A
PA
Bax
J J
JJ
D000787:Angina Pectoris / Q000209:etiology / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000401:mortality