Cardiac computed tomographic angiography for risk stratification and prediction of late cardiovascular outcome events in patients with a chest pain syndrome

Abstract

Background Contrast-enhanced multidetector cardiac computed tomographic angiography (CCTA) has high sensitivity and specificity for diagnosing anatomic coronary stenoses, but its role in predicting late clinical outcome events has not been well studied. Methods We examined predictive value of CCTA for late major adverse cardiovascular (CV) outcome events (MACE)(CV death, myocardial infarction, myocardial revascularization) (follow-up 18.2 ± 6.3, range 9–30 months) in 545 consecutive symptomatic patients (368 (68%) men, 177 (32%) women) with clinical suspicion, but without previously diagnosed, coronary artery disease (CAD) who underwent 40- or 64-channel CCTA. Results MACE occurred in 53/545 (9.7%) patients (early 30 day CCTA-driven events excluded): CV death/myocardial infarction in 3/327 (0.9%) patients with no coronary luminal narrowing > 25% (group 1), in 3/127 (2.4%) with ≥ 1 luminal narrowing(s) of 26–69% (group 2) and in 9/91 (9.9%) with ≥ 1 coronary luminal narrowing(s) of ≥ 70% (group 3) ( p < 0.0001). CV death/myocardial infarction/revascularization occurred in 5/327 (1.5%) group 1 patients, 19/127 (14.9%) group 2 and 29/91 (31.9%) group 3 ( p < 0.0001). Multivariate analysis (adjusting for age, gender, coronary risk factors and coronary calcium score) identified CCTA stenosis (> 25%) as a powerful independent predictor of MACE (HR 10.9, 95%CI 4.1–29.0, p < 0.0001). Conclusions CCTA was useful to predict late clinical outcome events in patients undergoing evaluation of a chest pain syndrome.