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Prognostic Value of Multidetector Coronary Computed Tomographic

Angiography for Prediction of All-Cause Mortality

Objectives: The purpose of this study was to examine the association of all-cause death with the coronary computed tomographic angiography (CCTA)-defined extent and severity of coronary artery disease (CAD).
Non-invasive Imaging: Cardiac Computed Tomography


Background

The prognostic value of identifying CAD by CCTA remains undefined. Methods We examined a single-center consecutive cohort of 1,127 patients ≥ 45 years old with chest symptoms. Stenosis by CCTA was scored as minimal (<30%), mild (30% to 49%), moderate (50% to 69%), or severe (≥70%) for each coronary artery. Plaque was assessed in 3 ways: 1) moderate or obstructive plaque; 2) CCTA score modified from Duke coronary artery score; and 3) simple clinical scores grading plaque extent and distribution. A 15.3 ± 3.9-month follow-up of all-cause death was assessed using Cox proportional hazards models adjusted for pretest CAD likelihood and risk factors. Deaths were verified by the Social Security Death Index.

Results

The CCTA predictors of death included proximal left anterior descending artery stenosis and number of vessels with ≥50% and ≥70% stenosis (all p < 0.0001).
A modified Duke CAD index, an angiographic score integrating proximal CAD, plaque extent, and left main (LM) disease, improved risk stratification (p < 0.0001).
Patients with <50% stenosis had the highest survival at 99.7%. Survival worsened with higher-risk Duke scores, ranging from 96% survival for 1 stenosis≥70% or 2 stenoses ≥50% (p = 0.013) to 85% survival for ≥50% LM artery stenosis (p < 0.0001).
Clinical scores measuring plaque burden and distribution predicted 5% to 6% higher absolute death rate (6.6% vs. 1.6% and 8.4% vs. 2.5%; p = 0.05 for both).

Conclusion:

In patients with chest pain, CCTA identifies increased risk for all-cause death. Importantly, a negative CCTA portends an extremely low risk for death.

J Am Coll Cardiol 2007;50:1161–70

The lack of prognostic data had been considered to be an important limitation for
non-invasive MDCT Coronary angiography. Min et al could show, that non-invasive coronary angiography is useful to further classify an individuals  risk. The present results reveal the prognostic value of CCTA findings and provide the first mortality data which may be used to guide clinical application of this new technology.

References


James K. Min, MD, Leslee J. Shaw, PHD, Richard B. Devereux, MD,
Peter M. Okin, MD, Jonathan W. Weinsaft, MD, Donald J. Russo, MD,
Nicholas J. Lippolis, MD, Daniel S. Berman, MD, Tracy Q. Callister, MD
New York, New York; Hendersonville, Tennessee; and Los Angeles, California
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.