title: Prognostic value of computed tomography coronary angiography in patients with chest pain of suspected cardiac origin.
abstract: OBJECTIVE
  The authors sought to determine the prognostic value of computed tomography coronary angiography (CTCA) in patients with acute chest pain (ACP).
  
  
  METHODS
  A total of 145 consecutive patients (75 men; 64±12 years) with ACP were referred from the Emergency Department for CTCA, which was performed with a standard protocol using a 64-slice scanner. Patients were stratified according to the Morise clinical score (low, intermediate, high) and to the CTCA findings [absence of coronary artery disease (CAD), nonobstructive CAD, obstructive CAD]. Patients were followed up for the occurrence of major events: cardiac death, nonfatal myocardial infarction, unstable angina and revascularisation.
  
  
  RESULTS
  One hundred and twenty-seven (87.6%) patients were without a history of CAD, and 18 (12.4%) patients had a history of CAD. Obstructive CAD (>50% luminal narrowing) was detected in 35 (24%) patients; nonobstructive CAD (≤ 50% luminal narrowing) in 62 (43%) and absence of CAD in 48 (33%) patients. During a mean follow-up of 20 ± 3 months, 20 events occurred (four hard events). Sixteen events (three hard events) occurred in patients without a history of CAD, and four events (one hard event) occurred in patients with a history of CAD. In patients with absence of CAD as detected by CTCA, the rate of events was 0%. At multivariate analysis, hypercholesterolaemia and obstructive CAD were significant predictors of events (p<0.05).
  
  
  CONCLUSIONS
  An excellent prognosis was observed in patients with ACP and normal CTCA. CTCA shows the potential for optimal stratification of patients with ACP.
authors.affiliation: Department of Radiology and Cardiology, c/o Piastra Tecnica, Piano 0, Azienda Ospedaliero-Universitaria, Via Gramsci 14, 43100, Parma, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Maffei
authors.forename: S
authors.initials: S
authors.lastname: Seitun
authors.forename: C
authors.initials: C
authors.lastname: Martini
authors.forename: A
authors.initials: A
authors.lastname: Aldrovandi
authors.forename: G
authors.initials: G
authors.lastname: Cervellin
authors.forename: C
authors.initials: C
authors.lastname: Tedeschi
authors.forename: A
authors.initials: A
authors.lastname: Guaricci
authors.forename: G
authors.initials: G
authors.lastname: Messalli
authors.forename: O
authors.initials: O
authors.lastname: Catalano
authors.forename: F
authors.initials: F
authors.lastname: Cademartiri
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging*; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed