title: Influence of coronary computed tomographic angiography on patient treatment and prognosis in patients with suspected stable angina pectoris.
abstract: We evaluated the influence of coronary computed tomographic angiography (CTA) as a first-line diagnostic test on patient treatment and prognosis. A total of 1,055 consecutive patients with suspected stable angina pectoris (mean age 55 ± 10 years, 56% women) and a low to intermediate pretest likelihood of coronary artery disease (CAD) were included in the present study. The patients were followed for a median of 18 months. The use of downstream diagnostic testing and medical therapy after CTA were recorded. The CTA result was normal in 49%, and nonobstructive and obstructive CAD (≥50% stenosis) was demonstrated in 31% and 15% of the patients, respectively. Coronary CTA was inconclusive in 5% of the patients. The use of antiplatelet therapy decreased with normal findings from CTA, and the use of antiplatelet and lipid-lowering agents increased in patients with CAD. Additional testing was performed in 2% of patients with normal CTA findings and in 7% and 82% of patients with nonobstructive or obstructive CAD, respectively. No patients without CAD, 0.9% of patients with nonobstructive CAD, and 1.9% of patients with obstructive CAD met the primary end point (cardiovascular death and myocardial infarction, p = 0.008). No patients without CAD, 1.5% of patients with nonobstructive CAD, and 30% patients with obstructive CAD met the secondary end point (cardiovascular death, myocardial infarction, and coronary revascularization, p <0.0001). In conclusion, in patients suspected of having angina, the findings from CTA influence patient treatment without resulting in excessive additional testing. Coronary CTA provides important prognostic information, with excellent intermediate-term outcomes in patients with normal CTA findings.
authors.affiliation: Department of Cardiology, Lillebælt Hospital Vejle, Denmark. kristianovrehus@hotmail.com
authors.forename: Kristian A
authors.initials: KA
authors.lastname: Ovrehus
authors.forename: Hans E
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Jesper M
authors.initials: JM
authors.lastname: Jensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Munkholm
authors.forename: Søren P
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Nørgaard
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D014057:Tomography, X-Ray Computed
chemical_list: D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors