Abstract 305: Cardiac CTA versus Standard of Care Strategies to Evaluate Patients With Potential Coronary Artery Disease: Effect on Long Term Clinical Outcomes
Previous studies have shown that CT angiography (CTA) in suspected coronary artery disease (CAD) patients predicts short term adverse events. We performed a study to assess whether information from CTA improved outcomes.
Methods: 4244 symptomatic patients (mean age 58±9, 62% male) without known CAD; 2538 who underwent CTA to evaluate for CAD and 1706 who recieved standard of care treatment in an academic cardiology clinic were studied. Patients were frequency-matched by age, gender, and conventional cardiac risk factors. The primary outcome measure was all cause mortality. Multivariable Cox proportional hazards models incorporated age, gender and risk factors for coronary disease.
Results: There was no significant differences in age, gender and conventional risk factors in both groups (P>0.05). During a mean follow up of 80±11 months, the death rate was 6.3% (270 deaths). Date rate was significantly lower in CTA group (n=86) as compared to the standard of care (n=184)(p=0.001). Event free survival was 96.7% and 89.3% in CTA and standard of care groups, respectively. Risk-adjusted hazard ratio of death were 4.1 (95%CI: 1.1–9.7, p=0.003) in standard of care cohort as compared to CTA group. Multivariate analysis demonstrated that undergoing coronary CTA resulted in a risk reduction of 52%, p=0.0001.
Conclusions: Increased awareness of coronary arterial disease severity among those undergoing CTA may have contributed to improved survival. Our results provide evidence of improved outcomes from scanning for atherosclerosis with CTA in symptomatic patients. Large randomized trials are warranted.