Abstract
BackgroundLimited studies report on the additional prognostic value of coronary computed tomography angiography (CCTA) and the coronary artery calcium score (CACS).MethodsFor a median of 637 days, 1551 outpatients with chest pain, without known coronary artery disease (CAD) and low or intermediate pre-test probability of CAD, were followed for major adverse cardiac events (MACE), defined as death, myocardial infarction or late revascularisation. Cox proportional hazard regression was used to evaluate the independent prognostic value of CCTA and CACS.ResultsMACE occurred in 23 patients (1.5 %): death (3, 0.2 %), myocardial infarction (4, 0.3 %) and late revascularisation (16, 1.3 %). Multivariate analysis showed an independent prognostic value of CCTA (p < 0.001), CACS of 100–400 (p = 0.035) and CACS of > 400 (p = 0.021). CCTA showed obstructive CAD in 3.1 % of patients with CACS = 0. No events occurred in patients with CACS = 0 without obstructive CAD at CCTA, whereas 2/23 patients (9 %) with CACS = 0 with obstructive CAD had a MACE.ConclusionsOur study shows that both CCTA and higher CACS categories have independent prognostic value in chest pain patients with low to intermediate pre-test probability of obstructive CAD, in which CCTA is appropriate. Furthermore a non-negligible amount of patients with CACS = 0 have obstructive CAD at CCTA. CCTA can be used in these patients to identify those at risk for MACE.
Highlights
Quantification of coronary artery calcium by computed tomography represents a reliable estimate of atherosclerotic plaque burden and the prognostic value of the coronary artery calcium score (CACS) is well established [1, 2]
Our study shows that in a routine clinical cohort of patients referred from the outpatient clinic with chest pain with low to intermediate pre-test probability of obstructive coronary artery disease (CAD), the CACS = 0
No events occurred during follow-up in patients with CACS = 0 and no obstructive CAD at coronary computed tomography angiography (CCTA) in our study and obstructive CAD at CCTA was significantly associated with a worse prognosis
Summary
Quantification of coronary artery calcium by computed tomography represents a reliable estimate of atherosclerotic plaque burden and the prognostic value of the coronary artery calcium score (CACS) is well established [1, 2]. The aim of this study was to evaluate the independent prognostic value of CCTA and CACS in a routine clinical cohort of symptomatic patients with low or intermediate pre-test probability, in which CCTA is appropriate. Limited studies report on the additional prognostic value of coronary computed tomography angiography (CCTA) and the coronary artery calcium score (CACS). Methods For a median of 637 days, 1551 outpatients with chest pain, without known coronary artery disease (CAD) and low or intermediate pre-test probability of CAD, were followed for major adverse cardiac events (MACE), defined as death, myocardial infarction or late revascularisation. Conclusions Our study shows that both CCTA and higher CACS categories have independent prognostic value in chest pain patients with low to intermediate pre-test probability of obstructive CAD, in which CCTA is appropriate. CCTA can be used in these patients to identify those at risk for MACE
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