Daniele Andreini MD, Presenter: Nothing to Disclose

Gianluca Pontone MD, Abstract Co-Author: Nothing to Disclose

Saima Mushtaq, Abstract Co-Author: Nothing to Disclose

Antonio Bartorelli, Abstract Co-Author: Nothing to Disclose

Erika Bertella, Abstract Co-Author: Nothing to Disclose

Edoardo Conte, Abstract Co-Author: Nothing to Disclose

Giovanni Ballerini, Abstract Co-Author: Nothing to Disclose

Alberto Formenti, Abstract Co-Author: Nothing to Disclose

Mauro Pepi, Abstract Co-Author: Nothing to Disclose

Purpose: Multidetector computed tomography coronary angiography (MDCT-CA) is increasingly used as imaging modality in patients with suspected coronary artery disease (CAD). Nowadays, limited data supporting the prognostic value of MDCT-CA in these patients. We evaluated, with a long follow-up, the prognostic role of MDCT-CA in a large population of patients without known cardiac disease but suspected CAD.

Methods: Between January 2004 and January 2008, 1344 patients were prospectively enrolled in the study. Each MDCT-CA was evaluated for type of coronary plaque, number of segments with each type of plaque and any obstructive plaques and quantification of coronary lesions. Patients were categorized as normal, non-obstructive CAD and obstructive CAD. Coronaries were also assessed by presence of obstructive lesions in major epicardial vessel, Duke prognostic CAD index and coronary plaque scores. The outcomes were a composite of hard cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina) and a composite of all cardiac events (including revascularization).

Results: Of the 1344 patients enrolled, 70 were excluded from the analysis because of the MDCT-CA data set was judged uninterpretable. Of the remaining 1274 patients, clinical follow-up (mean 52 ± 25 months) was obtained for 1196 (94%). In multivariate analysis, significant predictors of both all and hard cardiac events were the presence of non-obstructive CAD, obstructive CAD and Duke score 6. The cumulative event free survival rate was 100% for both all and hard events in patients with normal coronary arteries, 69% for all and 87% for hard events in patients with non-obstructive CAD, 16% for all and 75% for hard events in patients with obstructive CAD. About hard cardiac events, cumulative event free survival rate worsened with higher-risk Duke scores and multi-vessel CAD.

Conclusions: MDCT-CA-classified extent and severity of CAD provides incremental prognostic information in patients with suspected CAD. Non-obstructive CAD is related to significantly worsened prognosis in comparison with patients with normal coronary arteries.

This study demonstrated that MDCT coronary angiography provides a strong prognostic value in patients with suspicion of coronary artery disease but without documented cardiac disease

Andreini, D, Pontone, G, Mushtaq, S, Bartorelli, A, Bertella, E, Conte, E, Ballerini, G, Formenti, A, Pepi, M, Prognostic Value of Multidetector Computed Tomography Coronary Angiography in a Large Population of Patients with Unknown Cardiac Disease but Suspected Coronary Artery Disease: A 52-month Follow-up Study.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11008063.html