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Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood


Van Werkhoven, J; Gaemperli, O; Schuijf, J D; Jukema, J W; Kroft, L J; Leschka, S; Alkadhi, H; Valenta, I; Pundziute, G; De Roos, A; Van der Wall, E E; Kaufmann, P A; Bax, J J (2009). Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood. Heart, 95(19):1607-1611.

Abstract

OBJECTIVES: The purpose of this study was to assess whether MSCTA may be useful for risk stratification of patients with suspected CAD at intermediate pre-test likelihood according to Diamond and Forrester. Design and PATIENTS: MSCTA images were evaluated for the presence of significant CAD in 316 included patients (60% male, average age 57+/-11 years) with suspected CAD and an intermediate pre-test likelihood according to Diamond and Forrester. Patients were followed in time for the occurrence of an event. MAIN OUTCOME MEASURES: A combined endpoint of all cause mortality, non-fatal infarction, and unstable angina requiring revascularization. RESULTS: Significant CAD was observed in 89 patients (28%), whereas normal MSCTA or non-significant CAD was observed in the remaining 227 (72%) patients. During follow-up (median 621 days (95%-confidence interval: 408-835) an event occurred in 13 patients (4.8%). The annualized event rate was 0.8% in patients with normal MSCT, 2.2% in patients with non-significant CAD and 6.5% in patients with significant CAD. Moreover, MSCTA remained a significant predictor (p<0.05) of events after multivariate correction. CONCLUSIONS: Our results suggest that in an intermediate pre-test likelihood population, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasize the usefulness of non-invasive imaging with MSCTA in this patient population.

OBJECTIVES: The purpose of this study was to assess whether MSCTA may be useful for risk stratification of patients with suspected CAD at intermediate pre-test likelihood according to Diamond and Forrester. Design and PATIENTS: MSCTA images were evaluated for the presence of significant CAD in 316 included patients (60% male, average age 57+/-11 years) with suspected CAD and an intermediate pre-test likelihood according to Diamond and Forrester. Patients were followed in time for the occurrence of an event. MAIN OUTCOME MEASURES: A combined endpoint of all cause mortality, non-fatal infarction, and unstable angina requiring revascularization. RESULTS: Significant CAD was observed in 89 patients (28%), whereas normal MSCTA or non-significant CAD was observed in the remaining 227 (72%) patients. During follow-up (median 621 days (95%-confidence interval: 408-835) an event occurred in 13 patients (4.8%). The annualized event rate was 0.8% in patients with normal MSCT, 2.2% in patients with non-significant CAD and 6.5% in patients with significant CAD. Moreover, MSCTA remained a significant predictor (p<0.05) of events after multivariate correction. CONCLUSIONS: Our results suggest that in an intermediate pre-test likelihood population, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasize the usefulness of non-invasive imaging with MSCTA in this patient population.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > Center for Integrative Human Physiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Language:English
Date:October 2009
Deposited On:18 Aug 2009 12:34
Last Modified:13 Sep 2016 14:25
Publisher:BMJ Publishing Group
ISSN:1355-6037
Publisher DOI:10.1136/hrt.2009.167353
PubMed ID:19581272
Permanent URL: http://doi.org/10.5167/uzh-20260

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