title: Prognostic value of absence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography a systematic review and meta-analysis.
abstract: To determine via a meta-analysis the prognostic value of 64-slice computed tomography angiography (CTA) by quantifying risk of major adverse cardiac events (MACE) in different patient groups classified according to CT angiographic findings. A systematic literature search and meta-analyses was conducted on 10 studies examining stable, symptomatic and intermediate risk patients by 64-slice CTA. Patients were followed up for a mean of 21 month. Patient groups with CT-angiographic non-obstructive (stenosis <50% of luminal narrowing) or obstructive (stenosis ≥50% of luminal narrowing) CAD were compared to those having normal angiography without CAD. MACE (cardiac death, non-fatal myocardial infarction and revascularization) numbers were used to calculate odds ratios (OR) with 95% confidence interval (CI) in each group. Ten studies including 5,675 patients were eligible for meta-analysis. The cumulative MACE rate over 21 months were 0.5% in patients with normal CTA, 3.5% in non-obstructive CAD and 16% in obstructive CAD. Compared to normal CTA, non-obstructive CAD was associated with significant increased risk of MACE with OR=6.68 (3.01-14.82 CI 95%), P=0.0001. Obstructive CAD was associated with further significant increased risk of MACE with OR=41.19 (22.56-75.18, CI 95%), P=0.0001. The studies were homogenous, P-value >0.05 for heterogeneity. 64-slice CTA is able to differentiate low-risk from high-risk patients with suspected or known CAD. Absence of CAD predicts excellent prognosis, while obstructive CAD is associated with markedly increased risk of MACE.
authors.affiliation: Division of Cardiology, Department of Medicine, Glostrup University Hospital, Copenhagen, Denmark. jawab@dadlnet.dk
authors.forename: Jawdat
authors.initials: J
authors.lastname: Abdulla
authors.forename: Camilla
authors.initials: C
authors.lastname: Asferg
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed