RT Journal Article
SR Electronic
T1 Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1607
OP 1611
DO 10.1136/hrt.2009.167353
VO 95
IS 19
A1 J M van Werkhoven
A1 O Gaemperli
A1 J D Schuijf
A1 J W Jukema
A1 L J Kroft
A1 S Leschka
A1 H Alkadhi
A1 I Valenta
A1 G Pundziute
A1 A de Roos
A1 E E van der Wall
A1 P A Kaufmann
A1 J J Bax
YR 2009
UL http://heart.bmj.com/content/95/19/1607.abstract
AB 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.