Prognostic Value of Coronary CT Angiography

Study Questions:

What is the prognostic value of coronary artery disease (CAD) identified on coronary computed tomography angiography (CCTA)?

Methods:

This cohort study examined 16,949 patients from multiple centers with new-onset symptoms suggestive of CAD, and evaluated the relationship between CCTA findings and outcomes. Outcomes included late revascularization, myocardial infarction, and mortality.

Results:

Median age was 57 years, and 57% were women. CAD was absent, nonobstructive, and obstructive in 9,305, 4,900, and 2,744 subjects, respectively. Median follow-up was 3.6 years; late revascularization, myocardial infarction, and mortality were observed in 173, 105, and 261 individuals, respectively. The composite endpoint occurred in 1.5% of patients without CAD and 6.8% in those with obstructive CAD. Adjusted hazard ratios for events (using normal coronary arteries as a baseline) were 1.28 for nonobstructive CAD (95% confidence interval [CI], 1.01-1.63), 2.25 for obstructive CAD (95% CI, 1.73-2.92), and 4.41 (95% CI, 2.90-6.69) for three-vessel or left main obstructive CAD. By adding CAD identified by CCTA to a model using the Diamond-Forrester risk score and risk factors, the C-index for the model increased from 0.64 to 0.72 (p < 0.001).

Conclusions:

The authors concluded that CAD identified by CCTA is associated with an increased risk of adverse events.

Perspective:

Prior studies, particularly those from the CONFIRM registry, have observed that nonobstructive and obstructive CAD identified on CCTA are associated with an increased risk of adverse events. As with CONFIRM data, this study observes that CCTA results improve risk classification over clinical risk scores alone, and can help identify patients at an increased risk of events. Both CONFIRM and the present study demonstrate that the relationship between CAD on CCTA and outcomes persists across a range of subgroups, including both genders, different ages, and a range of comorbidities. These results support the prognostic value of CCTA in patients with symptoms concerning for CAD.

Clinical Topics: Acute Coronary Syndromes, Noninvasive Imaging, Stable Ischemic Heart Disease, Chronic Angina

Keywords: Acute Coronary Syndrome, Angina, Stable, Diagnostic Imaging, Comorbidity, Coronary Artery Disease, Middle Aged, Myocardial Infarction, Risk Factors


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