Abstract 2590: Prognostic Value Of Coronary Computed Tomography In Patients With Suspected Coronary Artery Disease In A Large Prospective Single Center Clinical Experience With 2 Years Follow-up
Background: Multislice computed tomography coronary angiography (CTCA) allows detection of coronary lesions with high diagnostic accuracy and has a high negative predictive value for excluding coronary artery disease (CAD) compared to coronary angiography. However the prognostic value of MSCT is unknown. The aim of this study was to determine the predictive value of CTCA for major cardiac events in patients with suspected coronary artery disease (CAD).
Methods: A total of 187 patients (119 men, age 62.5 ± 10.5 years) without known heart disease and suspected CAD underwent 64-slice CTCA (Somatom Sensation 64, Siemens). Patients were followed up at 2 years for the occurrence of cardiac death, nonfatal acute myocardial infarction (AMI), unstable angina requiring hospitalization, and cardiac revascularization.
Results: On a total of 2822 coronary segments, 42 (1.5%) were non evaluable because of motion artefacts. Mean cardiac frequency during the MSCT exam was 62.5 ± 10.2 bpm. In 65 (34.7%) patients CTCA showed complete absence of coronary artery atherosclerosis, in 87(46.5%) patients CTCA detected non obstructive coronary plaques (coronary plaques ≤50%), in 35 (18.8%) patients CTCA detected obstructive coronary lesions (>50%). Globally during the follow-up 3 AMI and 1 non cardiac death occurred. In patients with normal coronary arteries at CTCA, the event rate was 0%. Of the patients with non obstructive CAD, 3 underwent cardiac revascularization for angina. Of patients with obstructive CAD, 3 had AMI, 16 patients had cardiac revascularization and 1 patient had documented unstable angina but coronary anatomy was deemed not amenable to revascularization.
Conclusions: CTCA demonstrates a 100% negative predictive value for major cardiac events at 24 months follow-up in patients with normal coronary arteries. Cardiac event rate increases with CAD severity and is higher in patients with obstructive disease on CTCA.