Negative coronary CT angiography for chest pain assessment predicts low event rate in 5 years

Abstract

Coronary CT angiography (CTA) is becoming a popular investigation for chest pain. A negative coronary CTA is known to have a good negative predictive value for major adverse cardiovascular events in short term. The data on the long-term outcomes of negative coronary CTA are lacking. We aim to investigate the long-term prognostic value of negative coronary CTA in the evaluation of chest pain. This was a retrospective observational study involving 259 cases of coronary CTA on our registry from July 2004 to November 2006. All coronary CTA were performed with GE 16-slice CT and then GE 64-slice CT scanner in late 2006. A negative coronary CTA was defined as no single coronary segment with stenosis ≥50% based on American Heart Association 16-segment model. The end point of the study was defined as a composite of major cardiovascular events such as myocardial infarction, myocardial death or revascularisation. Seventy cases of 259 on the registry were diagnosed as negative studies. Mean follow-up period was 4.64 ± 0.6 years (range from 3.4 to 5.7 years). Of these negative studies, only one patient suffered from the end point during the follow-up. Thus, the negative predictive value of a negative coronary CTA for a long-term major cardiovascular event was 0.986 (95% confidence interval: 0.92-0.99). A negative coronary CTA in patients with a low or intermediate pretest probability for significant coronary artery disease predicts a low rate of major cardiovascular events within a 5-year period.