THE DIAGNOSTIC PERFORMANCE OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY COMPARED WITH INVASIVE CORONARY ANGIOGRAPHY IN SYMPTOMATIC PATIENTS: LONG–TERM PROGNOSTIC IMPLICATIONS

Abstract

Objective: We aimed to investigate the diagnostic accuracy of 64-multidetector coronary computed tomographic angiography (CCTA) for stable symptomatic patients and evaluate the relationship between severity of coronary artery disease (CAD), cardiovascular risk scores, and coronary artery calcium (CAC) scores. We also assessed the possible predictors of all-cause mortality at a median of 10 years of follow-up. Materials and Methods: This retrospective, observational study included 45 patients with suspected CAD who had undergone CCTA and invasive coronary angiography within the previous two weeks (67% male, mean age 62.1±10.72 years). Using CCTA, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated on a segment and patient basis analysis. The total CAC (Agatston units [AU]) and systematic coronary risk evaluation (SCORE) scores were calculated for each patient. Results: The CCTA NPV and PPV for the segment- and patient-based analyses were 97% and 100%, and 94% and 88%, respectively. CAC scores >100 AU reflected a higher incidence of significant CAD (OR=4.88, 95% CI 1.62–14.68 p<0.001), and CAC scores were significantly correlated with SCORE risk values (r=0.669, p<0.001). Ultimately, 6 patients (13.3%) died. Combined CAC and SCORE value and age significantly improved the prediction of all-cause mortality at a median of 10 years of follow-up (AUC=0.833, 95% CI 0.693–0.974, p=0.009). Conclusion: 64-multidetector CCTA has high diagnostic accuracy for detecting or excluding significant CAD. Moreover, CAC and SCORE risk score may provide valuable prognostic information for predicting long-term mortality and improving preventive therapies.