title: Prognostic performance of coronary computed tomography angiography in asymptomatic individuals as compared to symptomatic patients with an appropriate indication.
abstract: BACKGROUND
  Current Appropriatene Usa Criteria exclude coronary computed tomography angiography (CTA) in asymptomatic individuals. We compared the prognostic value of coronary CTA in asymptomatic individuals to symptomatic patients with "definitely appropriate" indications for coronary CTA.
  
  
  METHODS
  Consecutive patients without previously known CAD referred for a CTA exam were divided into 2 groups. One group consisted ofasymptomatic individuals, the other of symptomatic patients with a "definitely appropriate" indication for coronary CT (unable to exercise and/or with an uninterpretable electrocardiogram and at an intermediate pre-test probability of obstructive coronary artery disease). Patients that did not fit into either groups were excluded. The segment stenosis score (SSS) was calculated based on coronary CTA and patients were followed for a composite endpoint of all-cause death, acute myocardial infarction and late revascularization.
  
  
  RESULTS
  A total of 1080 patients (60 ± 12 years, 65% male) were included in the study (674 "asymptomatic" and 406 "appropriate"). SSS >4 was more frequent in "asymptomatic" than in "appropriate" CT data sets (27% vs 20%, p = 0.02). After a mean follow-up of 4.4 ± 1.8 yrs, 49 patients reached the composite endpoint. On multivariable analysis adjusting for CAD risk factors and symptoms, only a high-risk CTA study and past smoking were independently predictive of events.
  
  
  CONCLUSIONS
  Although currently not regarded as "definitely appropriate", the use of coronary CTA in a selected asymptomatic population had higher yield for identifying high-risk individuals than appropriately indicated studies in symptomatic patients and provided thequal prognostic information.
authors.affiliation: Casa de Saúde São José, Rua Macedo Sobrinho, 21 - Humaitá, Rio de Janeiro, 22271-080, RJ, Brazil; Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária, Rio de Janeiro, 21941-913, RJ, Brazil.
authors.forename: Gabriel Cordeiro
authors.initials: GC
authors.lastname: Camargo
authors.affiliation: Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária, Rio de Janeiro, 21941-913, RJ, Brazil.
authors.forename: Thais
authors.initials: T
authors.lastname: Peclat
authors.affiliation: Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária, Rio de Janeiro, 21941-913, RJ, Brazil.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Souza
authors.affiliation: Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária, Rio de Janeiro, 21941-913, RJ, Brazil; Clínica de Diagnóstico por Imagem, Av. Ataulfo de Paiva, 669 - Leblon, Rio de Janeiro, 22440-032, RJ, Brazil.
authors.forename: Ronaldo de Souza Leão
authors.initials: RS
authors.lastname: Lima
authors.affiliation: Casa de Saúde São José, Rua Macedo Sobrinho, 21 - Humaitá, Rio de Janeiro, 22271-080, RJ, Brazil; National Institute of Cardiology, R. das Laranjeiras, 374 - Laranjeiras, Rio de Janeiro, 22240-006, RJ, Brazil. Electronic address: ilangottlieb@gmail.com.
authors.forename: Ilan
authors.initials: I
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors
keywords: Appropriateness; Asymptomatic; Coronary artery disease; Coronary computed tomography angiography; Prognosis