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


van Werkhoven, J M; 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: To assess whether multislice computed tomography coronary angiography (MSCTA) may be useful for risk stratification of patients with suspected coronary artery disease (CAD) at intermediate pretest likelihood according to Diamond and Forrester. Design and PATIENTS: MSCTA images were evaluated for the presence of significant CAD in 316 patients with suspected CAD (60% male, average (SD) age 57 (11) years) and an intermediate pretest likelihood according to Diamond and Forrester. Patients were followed up to determine the occurrence of an event. MAIN OUTCOME MEASURES: A combined end point of all-cause mortality, non-fatal infarction and unstable angina requiring revascularisation. RESULTS: Significant CAD was seen in 89 patients (28%), whereas normal MSCTA or non-significant CAD was seen in the remaining 227 (72%) patients. During follow-up (median 621 days (25-75th centile 408-835) an event occurred in 13 patients (4.8%). The annualised 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 (hazard ratio = 3.460 (95% CI 1.142 to 10.480). CONCLUSIONS: The results suggest that in patients with an intermediate pretest likelihood, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasise the usefulness of non-invasive imaging with MSCTA in this patient population.

OBJECTIVES: To assess whether multislice computed tomography coronary angiography (MSCTA) may be useful for risk stratification of patients with suspected coronary artery disease (CAD) at intermediate pretest likelihood according to Diamond and Forrester. Design and PATIENTS: MSCTA images were evaluated for the presence of significant CAD in 316 patients with suspected CAD (60% male, average (SD) age 57 (11) years) and an intermediate pretest likelihood according to Diamond and Forrester. Patients were followed up to determine the occurrence of an event. MAIN OUTCOME MEASURES: A combined end point of all-cause mortality, non-fatal infarction and unstable angina requiring revascularisation. RESULTS: Significant CAD was seen in 89 patients (28%), whereas normal MSCTA or non-significant CAD was seen in the remaining 227 (72%) patients. During follow-up (median 621 days (25-75th centile 408-835) an event occurred in 13 patients (4.8%). The annualised 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 (hazard ratio = 3.460 (95% CI 1.142 to 10.480). CONCLUSIONS: The results suggest that in patients with an intermediate pretest likelihood, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasise 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 > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:5 July 2009
Deposited On:25 Sep 2009 18:33
Last Modified:05 Apr 2016 13:21
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-20743

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