Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease

Hadamitzky, Martin; Täubert, Sebastian; Deseive, Simon; Byrne, Robert A.; Martinoff, Stefan; Schömig, Albert; Hausleiter, Jörg

doi:10.1093/eurheartj/eht293

Cited by 173 publications

(64 citation statements)

References 20 publications

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“…Although older studies have compared the prognostic value of stress testing within each sex, there are few contemporary data on this issue (5-7). Furthermore, recent observational studies on the prognostic value of computed tomographic angiography (CTA) do not include sex-specific analyses (8,9). A fuller understanding of the prognostic performance of these tests could aid in selecting the diagnostic evaluation strategy for both women and men.…”

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confidence: 99%

Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease

Pagidipati

Hemal

Coles

et al. 2016

Journal of the American College of Cardiology

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Background Risk stratification is an important goal of cardiac noninvasive tests (NITs), yet little contemporary data exist on the prognostic value of different NITs by patient sex. Objectives To compare the results and prognostic information derived from anatomic versus stress testing in stable men and women with suspected coronary artery disease. Methods In 8966 PROMISE trial patients tested as randomized (4500 computed tomographic angiography [CTA], 52% female; 4466 stress testing, 53% female), we assessed the relationship between sex and NIT results using logistic regression, and the relationship between sex and a composite of death, myocardial infarction, and unstable angina hospitalization using Cox proportional hazards models. Results In women, a positive CTA (≥70% stenosis) was less likely than a positive stress test (8% vs. 12%, adjusted OR 0.67 [95% CI 0.55-0.82]). Compared with negative tests, a positive CTA was more strongly associated with subsequent clinical events than a positive stress test (CTA adjusted HR 5.86 [95% CI 3.32-10.35]; stress adjusted HR 2.27 [95% CI 1.21-4.25]; adjusted p=0.028). Men were more likely to have a positive CTA than stress test (16% vs. 14%, adjusted OR 1.23 [95% CI 1.04-1.47]). Compared with negative tests, a positive CTA was less strongly associated with subsequent clinical events than a positive stress test in men, although this difference was not statistically significant (CTA adjusted HR 2.80 [95% CI 1.76-4.45]; stress adjusted HR 4.42 [95% CI 2.77-7.07]; adjusted p=0.168). Negative CTA and stress tests were equally likely to predict an event in both sexes (adjusted p-values=NS). A significant interaction between sex, NIT type, and test result (p=0.01) suggests that sex and NIT type jointly influence the relationship between test result and clinical events. Conclusions The prognostic value of an NIT result varies by test type and patient sex. Women appear to derive more prognostic information from a CTA, while men tend to derive similar prognostic value from both test types.

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confidence: 99%

Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease

Pagidipati

Hemal

Coles

et al. 2016

Journal of the American College of Cardiology

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“…Similar to coronary angiography, a stepwise deterioration in prognosis associated with 1-, 2-, and 3-vessel disease has been observed using coronary CTA (49). Coronary CTA has also documented the adverse prognosis associated with nonobstructive disease (not detected with standard perfusion assessments) and confirmed the excellent prognosis for patients with a normal coronary CTA, with a risk of cardiovascular events of <0.5% that extends up to 5 years (50). Coupled with the excellent negative predictive value of a normal scan, coronary CTA is recommended in ruling out coronary artery disease in those considered at low or intermediate risk (51).…”

Section: Coronary Angiographymentioning

confidence: 72%

Computed Tomography and Cardiac Magnetic Resonance in Ischemic Heart Disease

Dweck

Williams

Moss

et al. 2016

Journal of the American College of Cardiology

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Ischemic heart disease is a complex disease process caused by the development of coronary atherosclerosis, with downstream effects on the left ventricular myocardium. It is characterized by a long preclinical phase, abrupt development of myocardial infarction, and more chronic disease states such as stable angina and ischemic cardiomyopathy. Recent advances in computed tomography (CT) and cardiac magnetic resonance (CMR) now allow detailed imaging of each of these different phases of the disease, potentially allowing ischemic heart disease to be tracked during a patient’s lifetime. In particular, CT has emerged as the noninvasive modality of choice for imaging the coronary arteries, whereas CMR offers detailed assessments of myocardial perfusion, viability, and function. The clinical utility of these techniques is increasingly being supported by robust randomized controlled trial data, although the widespread adoption of cardiac CT and CMR will require further evidence of clinical efficacy and cost effectiveness.

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“…In parallel, several retrospective analyses have demonstrated that CTCA-based imaging provides useful prognostic information and enables detection of patients that are likely to suffer a cardiovascular event amongst individuals with suspected CAD [95][96][97][98]146,147]. In patients with established CAD, a small scale study showed that CTCAderived variables were predictors of MACE at 5-year followup and improved considerably the prognostic accuracy of the model developed from the clinical variables (from 0.68 to 0.76) [148].…”

Section: Expert Commentarymentioning

confidence: 99%

Invasive or non-invasive imaging for detecting high-risk coronary lesions?

Patel

Tarkin

Serruys

et al. 2017

Expert Review of Cardiovascular Therapy

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Introduction: Advances in our understanding about atherosclerotic evolution have enabled us to identify specific plaque characteristics that are associated with coronary plaque vulnerability and cardiovascular events. With constant improvements in signal and image processing an arsenal of invasive and non-invasive imaging modalities have been developed that are capable of identifying these features allowing in vivo assessment of plaque vulnerability. Areas covered: This review article presents the available and emerging imaging modalities introduced to assess plaque morphology and biology, describes the evidence from the first large scale studies that evaluated the efficacy of invasive and non-invasive imaging in detecting lesions that are likely to progress and cause cardiovascular events and discusses the potential implications of the in vivo assessment of coronary artery pathology in the clinical setting. Expert commentary: Invasive imaging, with its high resolution, and in particular hybrid intravascular imaging appears as the ideal approach to study the mechanisms regulating atherosclerotic disease progression; whereas non-invasive imaging is expected to enable complete assessment of coronary tree pathology, detection of high-risk lesions, more accurate risk stratification and thus to allow a personalized treatment of vulnerable patients. ARTICLE HISTORY

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Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease

Abstract: Data from CCTA predict both death and myocardial infarction as well as need for subsequent revascularizations out to 5 years. CCTA imaging may be a valuable tool in the assessment of long-term prognosis in patients with suspected CAD.

Cited by 173 publications

References 20 publications

Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease

Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease

Computed Tomography and Cardiac Magnetic Resonance in Ischemic Heart Disease

Invasive or non-invasive imaging for detecting high-risk coronary lesions?

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