Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease

Objectives This study sought to determine the prognostic value of multislice computed tomography (MSCT) coronary angiography in patients with known or suspected coronary artery disease (CAD). Background It is expected that MSCT will be used increasingly as an alternative imaging modality in the diagnosis of patients with suspected CAD. Data on the prognostic value of MSCT, however, are currently not available. Methods A total of 100 patients (73 men, age 59 12 years) who were referred for further cardiac evaluation due to suspicion of significant CAD underwent additional MSCT coronary angiography to evaluate the presence and severity of CAD. Patients were followed up for the occurrence of: 1) cardiac death, 2) nonfatal myocardial infarction, 3) unstable angina requiring hospitalization, and 4) revascularization. Results Coronary plaques were detected in 80 (80%) patients. During a mean follow-up of 16 months, 33 events occurred in 26 patients. In patients with normal coronary arteries on MSCT, the first-year event rate was 0% versus 30% in patients with any evidence of CAD on MSCT. The observed event rate was highest in the presence of obstructive lesions (63%) and when obstructive lesions were located in the left main (LM)/left anterior descending (LAD) coronary arteries (77%). Nonetheless, an elevated event rate was also observed in patients with nonobstructive CAD (8%). In multivariate analysis, significant predictors of events were the presence of CAD, obstructive CAD, obstructive CAD in LM/LAD, number of segments with plaques, number of segments with obstructive plaques, and number of segments with mixed plaques. Conclusions Multislice computed tomography coronary angiography provides independent prognostic information over baseline clinical risk factors in patients with known and suspected CAD. An excellent prognosis was noted in patients with a normal MSCT.(c) 2007 by the American College of Cardiology Foundation