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Prognostic performance of low-dose coronary CT angiography with prospective ECG triggering
  1. Ronny R Buechel1,
  2. Aju P Pazhenkottil1,
  3. Bernhard A Herzog1,
  4. Michael Brueckner1,
  5. Rene Nkoulou1,
  6. Jelena R Ghadri1,
  7. Silke M Küest1,
  8. Christophe A Wyss1,
  9. Lars Husmann1,
  10. Philipp A Kaufmann1,2
  1. 1Department of Radiology, Cardiac Imaging, University Hospital Zurich, Switzerland
  2. 2Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
  1. Correspondence to Professor Philipp A Kaufmann, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland; pak{at}


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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  • See Editorial, p 1363

  • 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.

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