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Multi-slice Computed Tomography Coronary Angiography for Risk Stratification in Patients with an Intermediate Pre-test Likelihood
  1. Jacob Van Werkhoven (j.m.van_werkhoven{at}lumc.nl)
  1. Leiden University Medical Center, Netherlands
    1. Oliver Gaemperli
    1. University Hospital Zurich, Switzerland
      1. Joanne D Schuijf
      1. Leiden University Medical Center, Netherlands
        1. J Wouter Jukema
        1. Leiden University Medical Center, Netherlands
          1. Lucia J Kroft
          1. Leiden University Medical Center, Netherlands
            1. Sebastian Leschka
            1. University Hospital Zurich, Switzerland
              1. Hatem Alkadhi
              1. University Hospital Zurich, Switzerland
                1. Ines Valenta
                1. University Hospital Zurich, Switzerland
                  1. Gabija Pundziute
                  1. Leiden University Medical Center, Netherlands
                    1. Albert De Roos
                    1. Leiden University Medical Center, Netherlands
                      1. Ernst E Van der Wall
                      1. Leiden University Medical Center, Netherlands
                        1. Philipp A Kaufmann
                        1. University Hospital Zurich, Switzerland
                          1. Jeroen J Bax
                          1. Leiden University Medical Center, Netherlands

                            Abstract

                            Objectives: The purpose of this study was to assess whether MSCTA may be useful for risk stratification of patients with suspected CAD at intermediate pre-test likelihood according to Diamond and Forrester.

                            Design and patients: MSCTA images were evaluated for the presence of significant CAD in 316 included patients (60% male, average age 57±11 years) with suspected CAD and an intermediate pre-test likelihood according to Diamond and Forrester. Patients were followed in time for the occurrence of an event.

                            Main outcome measures: A combined endpoint of all cause mortality, non-fatal infarction, and unstable angina requiring revascularization.

                            Results: Significant CAD was observed in 89 patients (28%), whereas normal MSCTA or non-significant CAD was observed in the remaining 227 (72%) patients. During follow-up (median 621 days (95%-confidence interval: 408-835) an event occurred in 13 patients (4.8%). The annualized 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.

                            Conclusions: Our results suggest that in an intermediate pre-test likelihood population, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasize the usefulness of non-invasive imaging with MSCTA in this patient population.

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