Abstract
Introduction: The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries. However, as the prognostic outcome of patients with normal or non-significant finding on computed tomography coronary angiography (CTCA) is not well-known, this study was aimed to determine the prognostic value of CTCA in patients with either normal or non-significant CTCA findings. Methods: This retrospective cohort study was performed on patients who were referred for CTCA to the hospital. 527 patients with known or suspected coronary artery disease (CAD), who had undergone CTCA within one year were enrolled. Among them, data of 465 patients who had normal (no stenosis, n=362) or non-significant CTCA findings (stenosis <50% of luminal narrowing, n=103) were analyzed and prevalence of cardiac risk factors and major adverse cardiac events (MACE) were compared between these groups. In addition, a correlation between these factors and the number of involved coronary arteries was also determined. Results: After a mean follow-up duration of 13.11±4.63 months, all cases were alive except for three patients who died by non-cardiac events. Prevalence of MACE was 0% and 3% in normal CTCA group and non-significant groups, respectively. There was no correlation found between the number of involved coronary arteries and the prevalence of MACE (P = 0.57). Conclusion: A normal CTCA could be associated with extremely low risk of MACE over the first year after the initial imaging, whereas non-significant obstruction in coronary arteries may be associated with a slightly higher risk of MACE.
Highlights
The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries
Some investigations have reported excellent accuracy for multi-slice computed tomography coronary angiography (CTCA) compared with conventional coronary angiography,[8, 9] suggesting a potential role for this technique as an alternative first-line imaging modality appropriate for the diagnosis of patients suspected of having coronary artery disease (CAD).[10, 11]
Baseline characteristics There was no significant difference between groups in terms of the prevalence of hyperlipidemia, hypertension, family history of CAD and Smoking but those with nonsignificant CAD were older and more male than female and diabetes mellitus was more prevalent than normal group (29% vs. 15%)
Summary
Coronary artery disease (CAD) is the leading cause of death in the industrialized world.[1, 2] catheter coronary angiography has been considered as the gold standard for the diagnosis of CAD, it is an expensive and invasive diagnostic method with a small (0.1-0.2%) risk of major complications such as death, myocardial infarction and stroke.[3] it is highly desirable to find a primary non-invasive technique for the diagnosis of CAD.[4] The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries.[5] Several studies have been performed to evaluate the diagnostic performance of CT coronary angiography (CTCA) for the detection of significant CAD.[6, 7] Some investigations have reported excellent accuracy for multi-slice CTCA compared with conventional coronary angiography,[8, 9] suggesting a potential role for this technique as an alternative first-line imaging modality appropriate for the diagnosis of patients suspected of having CAD.[10, 11] In addition to non-invasiveness, CTCA has another major advantage of depicting the lumen and the wall of the coronary arteries It can determine whether the plaque is calcified or noncalcified and whether there is any associated positive or negative vascular remodeling.[12] It is important for both patients and clinicians to know how accurate CTCA detects or rules out CAD. Some CTCA studies showed that patients with severe CAD such as significant stenosis or multi-vessel disease
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