Abstract 12628: Incremental Prognostic Value of CT Coronary and Functional Findings for Predicting Major Adverse Cardiac Events in Emergency Department Patients with Chest Pain
Background: We sought to determine the incremental prognostic value of cardiac computed tomography (CT) for predicting major adverse cardiac events (MACE).
Methods: We followed 368 patients (53±12 years; 61% male) who presented to the ED with acute chest pain for a median period of 23 months. Contrast-enhanced 64-slice CT was obtained during index hospitalization and Results remained blinded to caregivers and patients. Primary endpoint was MACE, defined as cardiac death, nonfatal myocardial infarction, or coronary revascularization.
Results: At the end of the follow-up period, 25 (6.8%) patients had 34 MACE. There were no cardiac deaths, 12 patients with myocardial infarction, and 22 patients requiring coronary revascularizations. Figure 1 shows a gradient stepwise increase in the cumulative probability for MACE in patients with no stenosis or LV dysfunction, followed by patients with only one feature (either LV dysfunction or stenosis), with the highest in patients both stenosis and LV dysfunction. In Cox model adjusted for being on any cardiac medications, there was an 80-fold increase adjusted-risk in MACE for patients with both CT features of stenosis and LV dysfunction (hazard ratio [HR] 80.1, p<0.0001) and over 8-fold increase in adjusted-risk for patients with either stenosis (HR 8.7, p=0.01) or LV dysfunction (HR 10.8, p=0.0008) when compared to patients without stenosis or LV dysfunction. Both CT stenosis (HR 7.5, p<0.0001) and LV dysfunction (HR 12.3, p<0.0001) remained independently predictive of MACE, while the clinical TIMI risk score (p=0.96) was no longer significant after adding in CT findings. The c statistic for predicting MACE improved from 0.61 with the TIMI risk score alone to 0.84 when CT stenosis was added (p<0.0001), and further improved to 0.91 by adding LV dysfunction (p<0.0001).
Conclusions: CT coronary and functional features predict MACE and have incremental prognostic value beyond clinical risk score in ED patients with chest pain.
- © 2010 by American Heart Association, Inc.