Prognostic value of coronary computed tomographic angiography in comparison with calcium scoring and clinical risk scores.
BACKGROUND
Several studies have demonstrated a high accuracy of coronary computed tomography angiography (CCTA) for detection of obstructive coronary artery disease (CAD), whereas some studies have also shown a good prediction of cardiac events. However, it remains to be proven whether CCTA is better predictive of events than conventional risk scores or calcium scoring. Therefore, we compared CCTA with calcium scoring and clinical risk scores for the ability to predict cardiac events.


RESULTS
Patients (n=2223) with suspected CAD undergoing CCTA were followed up for a median of 28 months. The end point was the occurrence of cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and coronary revascularization later than 90 days after CCTA). Patients with obstructive CAD had a significantly higher event rate (2.9% per year; 95% confidence interval, 2.1 to 4.0) than those without obstructive CAD, having an event rate 0.3% per year (95% confidence interval, 0.1 to 0.5; hazard ratio, 13.5; 95% confidence interval, 6.7 to 27.2; P<0.001). CCTA had significant incremental predictive value when compared with calcium scoring, both with scores assessing the degree of stenosis (P<0.001) and with scores assessing the number of diseased coronary segments (P=0.027).


CONCLUSIONS
In patients with suspected CAD, CCTA not only detects coronary stenosis but also improves prediction of cardiac events over and above conventional risk scores and calcium scoring. This may result in a reclassification of cardiovascular risk in a substantial proportion of patients.
Hadamitzky
Martin
M
Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Hospital at the Technische Universität München, Munich, Germany. mhy@dhm.mhn.de
Distler
Roland
R
Meyer
Tanja
T
Hein
Franziska
F
Kastrati
Adnan
A
Martinoff
Stefan
S
Schömig
Albert
A
Hausleiter
Jörg
J
D000368:Aged; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol