Cargando…
The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study
OBJECTIVE: To prospectively assess the value of coronary CT angiography (CTA) in asymptomatic patients with high ‘a priori’ risk of coronary artery disease (CAD). METHODS: 711 consecutive asymptomatic patients (61.8 years; 40.1% female) with high ‘a priori’ risk of CAD were prospectively examined wi...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189305/ https://www.ncbi.nlm.nih.gov/pubmed/25332810 http://dx.doi.org/10.1136/openhrt-2014-000096 |
_version_ | 1782338345294102528 |
---|---|
author | Plank, Fabian Friedrich, Guy Dichtl, Wolfgang Klauser, Andrea Jaschke, Werner Franz, Wolfgang-Michael Feuchtner, Gudrun |
author_facet | Plank, Fabian Friedrich, Guy Dichtl, Wolfgang Klauser, Andrea Jaschke, Werner Franz, Wolfgang-Michael Feuchtner, Gudrun |
author_sort | Plank, Fabian |
collection | PubMed |
description | OBJECTIVE: To prospectively assess the value of coronary CT angiography (CTA) in asymptomatic patients with high ‘a priori’ risk of coronary artery disease (CAD). METHODS: 711 consecutive asymptomatic patients (61.8 years; 40.1% female) with high ‘a priori’ risk of CAD were prospectively examined with a coronary calcium score (CCS) and CTA. Coronary arteries were evaluated for atherosclerotic plaque (non-calcified and calcified) and stenosis (mild <50%, intermediate 50–70% or high-grade >70%). Coronary Segment Involvement Score (SIS, total number of segments with plaque) and nc (non-calcified) SIS were calculated. Primary end points were major adverse cardiac events (ST-elevation MI, non-ST-elevation MI and cardiac death); secondary end points were coronary revascularisation and >50% stenosis by invasive angiography. RESULTS: Of 711 patients, 28.3% were negative for CAD and 71.7% positive (CAD+) by CTA (15.6% had plaques without stenosis, 23.9% mild, 10.7% intermediate and 21.5% high-grade stenosis). CCS zero prevalence was 306 (43%), out of those 100 (32.7%) had non-calcified plaque only. Mean follow-up period was 2.65 years. MACE rate was 0% in CAD negative and higher (1.2%) in CAD positive by CTA. Coronary revascularisation rate was 5.5%. Patients with SIS ≥5 had an HR of 6.5 (95% CI 1.6 to 25.8, p<0.013) for MACE, patients with ncSIS ≥1 had an HR of 2.4 (95% CI 1.2 to 4.6, p<0.01) for secondary end point. The sensitivity of CTA for stenosis >50% compared with invasive angiography was 92.9% (95% CI 83.0% to 98.1%). Negative predictive value of CTA was 99.4% (95% CI 98.3% to 99.8%) for combined end points. CONCLUSIONS: CAD prevalence by CTA in asymptomatic high-risk patients is high. CCS zero does not exclude CAD. CTA is highly accurate to exclude CAD. Total coronary plaque burden and nc plaques, even if only one segment is involved, are associated with an increased risk of adverse outcome. |
format | Online Article Text |
id | pubmed-4189305 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-41893052014-10-20 The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study Plank, Fabian Friedrich, Guy Dichtl, Wolfgang Klauser, Andrea Jaschke, Werner Franz, Wolfgang-Michael Feuchtner, Gudrun Open Heart Coronary Artery Disease OBJECTIVE: To prospectively assess the value of coronary CT angiography (CTA) in asymptomatic patients with high ‘a priori’ risk of coronary artery disease (CAD). METHODS: 711 consecutive asymptomatic patients (61.8 years; 40.1% female) with high ‘a priori’ risk of CAD were prospectively examined with a coronary calcium score (CCS) and CTA. Coronary arteries were evaluated for atherosclerotic plaque (non-calcified and calcified) and stenosis (mild <50%, intermediate 50–70% or high-grade >70%). Coronary Segment Involvement Score (SIS, total number of segments with plaque) and nc (non-calcified) SIS were calculated. Primary end points were major adverse cardiac events (ST-elevation MI, non-ST-elevation MI and cardiac death); secondary end points were coronary revascularisation and >50% stenosis by invasive angiography. RESULTS: Of 711 patients, 28.3% were negative for CAD and 71.7% positive (CAD+) by CTA (15.6% had plaques without stenosis, 23.9% mild, 10.7% intermediate and 21.5% high-grade stenosis). CCS zero prevalence was 306 (43%), out of those 100 (32.7%) had non-calcified plaque only. Mean follow-up period was 2.65 years. MACE rate was 0% in CAD negative and higher (1.2%) in CAD positive by CTA. Coronary revascularisation rate was 5.5%. Patients with SIS ≥5 had an HR of 6.5 (95% CI 1.6 to 25.8, p<0.013) for MACE, patients with ncSIS ≥1 had an HR of 2.4 (95% CI 1.2 to 4.6, p<0.01) for secondary end point. The sensitivity of CTA for stenosis >50% compared with invasive angiography was 92.9% (95% CI 83.0% to 98.1%). Negative predictive value of CTA was 99.4% (95% CI 98.3% to 99.8%) for combined end points. CONCLUSIONS: CAD prevalence by CTA in asymptomatic high-risk patients is high. CCS zero does not exclude CAD. CTA is highly accurate to exclude CAD. Total coronary plaque burden and nc plaques, even if only one segment is involved, are associated with an increased risk of adverse outcome. BMJ Publishing Group 2014-08-12 /pmc/articles/PMC4189305/ /pubmed/25332810 http://dx.doi.org/10.1136/openhrt-2014-000096 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ |
spellingShingle | Coronary Artery Disease Plank, Fabian Friedrich, Guy Dichtl, Wolfgang Klauser, Andrea Jaschke, Werner Franz, Wolfgang-Michael Feuchtner, Gudrun The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study |
title | The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study |
title_full | The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study |
title_fullStr | The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study |
title_full_unstemmed | The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study |
title_short | The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study |
title_sort | diagnostic and prognostic value of coronary ct angiography in asymptomatic high-risk patients: a cohort study |
topic | Coronary Artery Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189305/ https://www.ncbi.nlm.nih.gov/pubmed/25332810 http://dx.doi.org/10.1136/openhrt-2014-000096 |
work_keys_str_mv | AT plankfabian thediagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT friedrichguy thediagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT dichtlwolfgang thediagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT klauserandrea thediagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT jaschkewerner thediagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT franzwolfgangmichael thediagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT feuchtnergudrun thediagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT plankfabian diagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT friedrichguy diagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT dichtlwolfgang diagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT klauserandrea diagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT jaschkewerner diagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT franzwolfgangmichael diagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy AT feuchtnergudrun diagnosticandprognosticvalueofcoronaryctangiographyinasymptomatichighriskpatientsacohortstudy |