Abstract 4716: Prognostic Value of Coronary Artery Calcium Scoring and Multi-slice Computed Tomography Coronary Angiography in Symptomatic Patients with Suspected Coronary Artery Disease
Objectives: Extensive data support the prognostic value of coronary calcium scoring (CS). Only preliminary data are available on the prognostic value of multi-slice computed tomography coronary angiography (CTA). Furthermore it is unclear which of these non-invasive anatomic imaging techniques is superior for risk stratification. The purpose of this study was therefore to assess the relative prognostic values of CS and CTA in symptomatic patients with suspected coronary artery disease.
Methods: In 509 patients (59% male, age 59 ±11 years) referred for cardiac evaluation due to the presence of symptoms, both CS testing and 64-slice CTA was performed. Abnormal CTA was defined as the presence of a significant ≥50% stenosis. The following events were recorded: all cause death, non-fatal infarction, and unstable angina requiring hospitalization. To determine the relative prognostic values, univariate and multivariate cox proportional hazard analysis were performed.
Results: The average CS was 325 ±741. Coronary calcifications were absent in 168 (33%) patients, CS 1–10 was present in 36 (7%), CS 11–100 in 104 (20%), CS 101– 400 in 88 (17%), CS 401–1000 in 66 (13%), and CS>1000 in 47 (9%). Significant (>50% stenosis) CAD was observed on CTA in 155 (31%) patients. During follow-up (average 1.6 ±0.9 years), an event occurred in 22 (4%) patients. Univariate predictors of events were: an abnormal CTA (hazard ratio (HR) 3.6, 95%-confidence interval (95%-CI): 1.5– 8.6); CS>100 (HR 2.8, 95%-CI: 1.1– 6.9); and CS>1000 (HR 3.6, 95%-CI: 1.4 –9.1). After correcting for age, gender, risk factors, and CTA in a multivariate model, none of the CS categories reached statistical significance. CTA however remained an independent predictor of events when correcting for age, gender, risk factors and CS>100 or CS>1000.
Conclusion: CTA may provide more detailed information on the presence and extent of atherosclerosis than CS alone. Indeed, the results of the current study suggest that CTA may result in better risk stratification compared to CS in symptomatic patients with suspected CAD.