Prevalence of severe subclinical coronary artery disease on cardiac CT and MRI in patients with extra-cardiac arterial disease.
OBJECTIVE
Patients with extra-cardiac arterial disease (ECAD) are at high risk of coronary artery disease (CAD). Prevalence of silent, significant CAD in patients with stenotic or aneurysmal ECAD was examined. Early detection and treatment may reduce CAD mortality in this high-risk group.


METHODS
ECAD patients without cardiac complaints underwent computed tomography (CT) for calcium scoring, coronary CT angiography (cCTA) if calcium score was 1,000 or under, and adenosine perfusion magnetic resonance imaging (APMR) if there was no left main stenosis. Significant CAD was defined as calcium score over 1,000, cCTA-detected coronary stenosis of at least 50% lumen diameter, and/or APMR-detected inducible myocardial ischemia. In cases of left main stenosis (or equivalent) or myocardial ischemia, patients were referred to a cardiologist.


RESULTS
The prevalence of significant CAD was 56.8% (95% CI 47.5 to 66.0). One-hundred and eleven patients were included. Eighty-four patients (76%) had stenotic ECAD, and 27 (24%) had aneurysmal disease. In patients with stenotic ECAD, significant coronary stenosis was present in 32 (38%) and inducible ischemia in eight (12%). Corresponding results in aneurysmal ECAD were eight (30%) and two (11%), respectively (p for difference >.05). Sixteen (19%) patients with stenotic and six (22%) with aneurysmal ECAD were referred to a cardiologist, with subsequent cardiac intervention in seven (44%) and three (50%), respectively (both p >.05).


CONCLUSIONS
Patients with stenotic or aneurysmal ECAD have a high prevalence of silent, significant CAD.
Center for Medical Imaging - North East Netherlands, The Netherlands; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
M A M
MA
den Dekker
J J A M
JJ
van den Dungen
I F J
IF
Tielliu
R A
RA
Tio
M M J J R
MM
Jaspers
M
M
Oudkerk
R
R
Vliegenthart
D000241:Adenosine; D000368:Aged; D058070:Asymptomatic Diseases; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000145:classification; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D000241:Adenosine
Computed tomography; Coronary artery disease; Magnetic resonance imaging; Peripheral artery disease; Prevalence