title: Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction.
abstract: OBJECTIVE
  We sought to determine the prognostic and incremental value of coronary artery disease (CAD) severity, coronary atherosclerosis, and left ventricular ejection fraction (LVEF) measured with cardiac computed tomography angiography (CTA).
  
  
  BACKGROUND
  CTA is an emerging tool used for the detection of obstructive CAD. However, there are limited data supporting the prognostic value of 64-slice CTA and its ability to predict all-cause mortality and major adverse cardiac events such as cardiac death and nonfatal myocardial infarction.
  
  
  METHODS
  Consecutive patients (without history of revascularization, heart transplantation, and congenital heart disease) were prospectively enrolled. Each CTA was evaluated for CAD severity, total plaque score, and LVEF. Patients were followed, and all events were confirmed with death certificates or hospital or physician records and reviewed by a clinical events committee.
  
  
  RESULTS
  Between February 2006 and February 2008, 2,076 consecutive patients were prospectively enrolled and followed for a mean of 16 +/- 8 months. At follow-up, a total of 31 (1.5%) patients had cardiac death or nonfatal myocardial infarction and 47 (2.3%) had all-cause mortality or nonfatal myocardial infarction. Multivariate analysis showed that CAD severity (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.89 to 4.83) was a predictor of major adverse cardiac events and that LVEF (HR: 1.47; 95% CI: 1.17 to 1.86) had incremental value over CAD severity. Total plaque score had incremental value over CAD severity and LVEF for all-cause mortality and nonfatal myocardial infarction (HR: 1.17; 95% CI: 1.06 to 1.29).
  
  
  CONCLUSIONS
  Using CTA, CAD severity, LVEF, and total plaque score seems to have prognostic and incremental value over routine clinical predictors. Cardiac CTA seems to be a promising noninvasive modality with prognostic value.
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. bchow@ottawaheart.ca
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.forename: Yeung
authors.initials: Y
authors.lastname: Yam
authors.forename: Paul
authors.initials: P
authors.lastname: Galiwango
authors.forename: Arun
authors.initials: A
authors.lastname: Abraham
authors.forename: Tej
authors.initials: T
authors.lastname: Sheth
authors.forename: Carole
authors.initials: C
authors.lastname: Dennie
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
authors.forename: Terrence D
authors.initials: TD
authors.lastname: Ruddy
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D036542:Tomography, Spiral Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology