Author + information
- Dominik C. Benz,
- Fran Mikulicic,
- Christoph Gräni,
- Dominic Moret,
- Oliver Gaemperli,
- Ronny Buechel,
- Aju Paul Pazhenkottil and
- Philipp Kaufmann
Background: Estimation of hemodynamic relevance of a coronary stenosis by fractional flow reserve (FFRCT) from coronary computed tomography angiography (CCTA) has raised substantial clinical interest. Since its calculation is a cumbersome process, the corrected contrast opacification (CCO) decrease across a stenosis has evolved as a faster and less complex alternative with promising diagnostic accuracy. The aim of the present study was to evaluate whether the diagnostic accuracy of CCO decrease translates into an added prognostic value in patients evaluated for coronary artery disease (CAD).
Methods: The present retrospective study consists of 161 consecutive patients who were referred for evaluation of known or suspected CAD with prospectively ECG-triggered CCTA. Patients with a history of revascularization were excluded. Mean attenuation of the coronary lumen was measured before and after a stenosis and corrected to the aorta to calculate CCO. The difference between CCO before and after the stenosis was defined as CCO decrease. A threshold of >0.184 was considered abnormal. CCO decrease was unavailable at the time of decision-making and, thus, had no impact on patient management. The following major adverse cardiac events (MACE) were used as endpoints: death, myocardial infarction, unstable angina requiring hospitalization, and coronary revascularization. Multivariate Cox regression was analyzed with covariates age, sex, 3 or more cardiovascular risk factors and stenosis severity.
Results: CCO decrease was successfully assessed in all patients with a stenosis (n=72). During a median follow-up of 6.1 years (interquartile range, 5.8-6.9), 65 MACE occurred in 55 patients. Among patients with a stenosis, the presence of an abnormal CCO decrease was associated with a higher annual MACE rate (13% vs. 8%) and a worse MACE-free survival (p<0.05). In multivariate Cox regression, CCO decrease was an independent predictor of MACE (HR: 2.27, 95% CI: 1.14-4.52, p<0.05).
Conclusions: In patients with a coronary stenosis, CCO decrease adds long-term prognostic value over clinical characteristics and stenosis severity.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1247-230
- 2017 American College of Cardiology Foundation