Abstract 310: The LongTerm Prognostic Competence of Coronary CT Angiography in Low Risk ED Chest Pain Patients
Introduction: Coronary CT angiography, (CCTA) can accurately establish or exclude coronary events in low risk ED chest pain patients at 90 days, however the long term predictive value or CCTA to exclude major adverse cardiac events (MACE) is unknown. Our objective was to establish the long term predictive value of CCTA for MACE through follow-up of patients enrolled in 2 previously published trials.
Methods: Follow up was attempted in 284 low risk, (TIMI ≤ 3) ED chest pain patients. 197 whom were randomized to either stress nuclear imaging, (SNI), or CCTA and 97 who underwent both CCTA and SNI. Patients were followed-up by utilizing hospital charts, office visits, phone follow-up and/or certified letter and if still unable to contact, the death index was queried. Outcome measures were MACE, defined as cardiovascular death, AMI, PCI, and hospitalizations for cardiac etiologies, at 2 years not detected at the initial visit.
Results: Follow-up was on average of 3.7 yrs from testing of enrollment. To date 87% (95% CI 82% – 90%) of patients had follow-up at 2 years and 50% (46%–54%) at 3.7 years. Major findings are summarized in table⇓ form. There were 4 deaths all in the SNI group, none were cardiac related, 2 to cancer, 1 suicide and 1 PE. Of the 185 patients who received CCTA and had ≤ 50 % stenosis on intial study, no MACE events were missed at 4 years. The SOC arm on the other hand missed 2 AMIs, both requiring PCI at an average of 22 mos from randomization, both SNI were normal initially. Hospitalizations for suspected cardiac cause, rates of EC visits for potential cardiac complaints and rate of repeat stress testing was similar between the 2 studies.
Conclusion: At nearly 4 year follow-up the ability of CCTA to exclude MACE is similar to that of a stress testing protocol. The long term prognostic competence of CCTA to detect MACE in low risk ED chest pain patients with ≤ 50% stenosis is excellent.