Morphologic and functional assessment of coronary artery disease--potential application of computed tomography angiography and myocardial perfusion imaging.
BACKGROUND
The role of combined evaluation of myocardial perfusion imaging (MPI; by single-photon emission computed tomography) and computed tomography angiography (CTA) for risk stratification of coronary artery disease was evaluated. For CTA, the extent of luminal stenosis, and also the features of high-risk plaques (HRP, including positive remodeling and low attenuation) were evaluated.


RESULTS
A total of 304 patients (65 ± 11 years, male 72%, median follow-up: 24 months) who underwent CTA and MPI were enrolled in the study. Summed stress scores and summed difference scores (SDS) for MPI, stenosis, and HRP were evaluated, and event rates were compared. Cardiac events were defined as acute coronary event including cardiac death or non-fatal acute myocardial infarction, and unstable angina requiring revascularization. Of 304 patients, 51 (16.8%) underwent early revascularization. In the remaining 253 patients, an event occurred in 11 (4.3%). HRP (hazard ratio [HR], 4.75, P=0.00171) and stenosis (+) with SDS >0 (HR, 4.58, P=0.0461) were significant independent predictors of cardiac event. The event rate for stenosis (+) with SDS >0 was significantly higher than others (log-rank P=0.0490). The event rates were significantly different between HRP(+) and HRP(-) (16.1% vs. 2.7%, log-rank P=0.0013).


CONCLUSIONS
HRP on CTA was an independent predictor of acute coronary events, as was stenosis (+) with SDS >0, and HRP had increased prognostic value over stenosis and abnormal MPI findings.
Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan. sadakom@fujita-hu.ac.jp
Sadako
S
Motoyama
Masayoshi
M
Sarai
Kaori
K
Inoue
Hideki
H
Kawai
Hajime
H
Ito
Hiroto
H
Harigaya
Kayoko
K
Takada
Yoshihiro
Y
Sanda
Hirofumi
H
Anno
Hiroyuki
H
Naruse
Junnichi
J
Ishii
Yukio
Y
Ozaki
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed