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CT angiography shows incremental prognostic benefit
Recently evidence has emerged suggesting the prognostic value of CT coronary angiography, however whether it can provide extra information over and above routine clinical workup—including exercise treadmill testing—remains uncertain. Dedic et al determined to answer this question in patients with stable chest pain and suspected coronary artery disease.
The study enrolled 471 patients who underwent exercise ECG testing and CT coronary angiography, with exercise ECG tests being classified as either normal, ischaemic, or non diagnostic. The primary outcome measure was a major adverse cardiac event (MACE), defined either as cardiac death, non-fatal myocardial infarction, or unstable angina requiring hospitalisation and revascularisation (beyond 6 months). Univariable and multivariable Cox regression analysis was used to determine the prognostic values, while clinical impact was assessed with the net reclassification improvement metric.
Over a mean follow-up of 2.6 years 44 MACEs occurred in 30 patients. The presence of coronary calcification (HR, 8.22), obstructive coronary artery disease (HR, 6.22), and nondiagnostic stress test results (HR, 3.00) were univariable predictors of MACEs. In the multivariable model, CT angiography findings (HR, 5.0) and non-diagnostic exercise ECG results (HR, 2.9) remained independent pre-dictors of MACEs. CT angiography findings showed incremental value beyond clinical predictors and stress testing (p<0.001), whereas coronary calcium scores did not have further incremental value (p=0.40).