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Cardiac imaging and non-invasive testing
Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood
  1. J M van Werkhoven1,2,
  2. O Gaemperli3,4,
  3. J D Schuijf1,
  4. J W Jukema1,2,
  5. L J Kroft5,
  6. S Leschka6,
  7. H Alkadhi6,
  8. I Valenta4,
  9. G Pundziute1,
  10. A de Roos5,
  11. E E van der Wall1,2,
  12. P A Kaufmann4,7,
  13. J J Bax1
  1. 1
    Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2
    The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
  3. 3
    Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
  4. 4
    Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
  5. 5
    Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
  6. 6
    Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
  7. 7
    Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr J van Werkhoven, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; j.m.van_werkhoven{at}lumc.nl

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.

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Footnotes

  • Funding JMvW is financially supported by a research grant from the Netherlands Society of Cardiology (Utrecht, The Netherlands). GP is financially supported by a training fellowship grant of the European Society of Cardiology (Sophia Antipolis, France) Huygens scholarship. HA is supported by the by the National Centre of Competence in Research, Computer Aided and Image Guided Medical Interventions of the Swiss National Science Foundation (Zurich, Switzerland) and has research grants from Siemens Medical Solutions (Forchheim, Germany). PAK is supported by a grant from the Swiss National Science Foundation (Berne, Switzerland) (SNSF-professorship grant No PPOOA-114706), and has research grants from GE Healthcare (Milwaukee, Wisconsin, USA). JJB has research grants from Medtronic (Tolochenaz, Switzerland), Boston Scientific (Maastricht, The Netherlands), BMS Medical Imaging (N Billerica, Massachusetts, USA), St Jude Medical (Veenendaal, The Netherlands), Biotronik (Berlin, Germany), GE Healthcare (St Giles, UK) and Edwards Lifesciences (Saint-Prex, Switzerland).

  • Competing interests None declared.

  • Ethics approval Approval from Leiden University Medical Centre and University Hospital Zurich.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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