title: Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris.
abstract: The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16 %) and during a median follow-up of 19 months (range 12-22 months) 25 patients (10 %) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations). Accuracy for the prediction of MACE expressed as the area under curve (AUC) on receiver-operating characteristic curves was 0.88 (0.83-0.92) for visual assessment of a PD and 0.80 (0.73-0.85) for stress TPR (transmural perfusion ratio). After adjustment for the pretest probability of obstructive coronary artery disease, both detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ratio of 39 (95 % confidence interval 11-134), p < 0.0001, for visual interpretation and 0.99 (0.98-0.99) for stress TPR, p < 0.0001. Patients with a PD volume covering >10 % of the LV myocardium had a worse prognosis compared to patients with a PD covering <10 % of the LV myocardium, p = 0.0002. The optimal cut-off value of the myocardial PD extent to predict MACE was 5.3 % of the left ventricle [sensitivity 84 % (64-96), specificity 95 % (91-97)]. Myocardial CT perfusion parameters predict mid-term clinical outcome in patients with recent acute-onset chest pain.
authors.affiliation: Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard alle 30, 2650, Hvidovre, Denmark. jesper_linde@hotmail.com.|Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. jesper_linde@hotmail.com.
authors.forename: Jesper J
authors.identifier: http://orcid.org/0000-0002-2101-5098
authors.initials: JJ
authors.lastname: Linde
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mathias
authors.initials: M
authors.lastname: Sørgaard
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jørgen T
authors.initials: JT
authors.lastname: Kühl
authors.affiliation: Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard alle 30, 2650, Hvidovre, Denmark.|Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: Jens D
authors.initials: JD
authors.lastname: Hove
authors.affiliation: Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.affiliation: Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard alle 30, 2650, Hvidovre, Denmark.
authors.forename: Walter B
authors.initials: WB
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.|Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kofoed
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019540:Area Under Curve; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Chest pain; Coronary artery disease; Myocardial CT perfusion; Transmural perfusion ratio