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With the progressive advancement of multi-slice coronary computed tomography angiography (CCTA) technology, CCTA has demonstrated a high sensitivity for the detection of obstructive and non-obstructive coronary artery disease (CAD). In addition to its applicability for the accurate diagnosis of CAD, patient prognosis has been shown to directly correlate with the severity of CAD diagnosed by CCTA. However, its long-term prognostic value has not been well elucidated. Therefore, we sought to investigate the rate of major adverse cardiovascular events based upon the severity of CAD by CCTA over a 6 year follow up period.
We performed a retrospective chart review of all CCTA studies performed in our institution to evaluate the incidence of death, myocardial infarction, stroke, re-evaluation for chest pain syndrome from January 2005 until present. We reviewed 1273 CCTA results over at least a six-year period between January 2005 and July 2011 (mean follow up period = 36 months), dividing results into groups with obstructive, non-obstructive, and no angiographic evidence of coronary artery disease, defined as >50% stenosis, ≤50% stenosis or coronary calcium, and no disease, respectfully. Subsequent primary endpoint MACE data (incidence of death, myocardial infarction, stroke, and re-evaluation for chest pain syndrome) were obtained from this patient cohort.
Over at least a six-year period, the rate of major adverse cardiovascular events in those with obstructive CAD by CCTA was 34.3%, compared to 18.1% in those with no disease (P value <0.003), with a trend towards significance in terms of the MACE rate based upon the severity of CAD. There were significantly more patients with obstructive disease who suffered a stroke or were re-admitted for chest pain relative to those without disease by CCTA. The rate of myocardial infarction also trended towards significance based upon the severity of CAD.
After over 6 years of follow up, the longest follow up period to date, obstructive CAD by CCTA is associated with increased major adverse cardiovascular events.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Coronary Risk Factors and Management
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1115-103
- 2013 American College of Cardiology Foundation