Objective To assess the prognostic value of low-dose 64-slice coronary CT angiography (CCTA) using prospective ECG triggering in a patient population with known or suspected coronary artery disease (CAD).
Design Longitudinal follow-up study.
Setting Tertiary referral cardiac imaging centre.
Patients 434 consecutive patients who were referred for evaluation of CAD by CCTA.
Methods The presence, distribution and severity of coronary lesions (non-obstructive <50% vs obstructive ≥50% luminal narrowing) were recorded by low-dose prospective ECG-triggered CCTA for each patient. The prognostic value of low-dose CCTA to predict major adverse cardiac events, defined as cardiac death, non-fatal myocardial infarction, or the need for revascularisation, was assessed using multivariate Cox regression analysis. Each person was followed up by telephone interviews and/or on the basis of clinical records. Thirty-eight early revascularised patients were excluded from outcome analysis.
Results Completely normal coronary arteries were documented in 171 patients (47%), while exclusively non-obstructive lesions were found in 66 (18%), and obstructive coronary lesions were diagnosed in 130 patients (35%). A mean follow-up of 47±16 weeks was obtained. The first-year event rate was 0% in patients with normal coronary arteries on CCTA but increased to 3% and 26% in patients with non-obstructive and obstructive coronary artery lesions, respectively. In multivariate Cox regression analysis, a significant predictor of events was the presence of obstructive or any coronary lesions. Mean effective radiation dose was 1.8±0.6 mSv.
Conclusions These data document an excellent prognostic performance of low-dose CCTA.
- CT coronary angiography
- prospective triggering
- low dose
- dose reduction
- prognostic value
- CT scanning
- coronary artery disease (CAD)
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Funding This work was supported by the Swiss National Science Foundation and the Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland.
Competing interests The University Hospital Zurich holds a research contract with GE Healthcare.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the institutional review board of the University Hospital Zurich.
Provenance and peer review Not commissioned; externally peer reviewed.