Nirmal Kakani MD, Presenter: Nothing to Disclose

Robin Vanlingen, Abstract Co-Author: Nothing to Disclose

Alice Marina Veitch MBChB, Abstract Co-Author: Nothing to Disclose

Nathan Manghat, Abstract Co-Author: Nothing to Disclose

Carl Ashley Roobottom MBChB, Abstract Co-Author: Nothing to Disclose

Gareth Morgan Hughes, Abstract Co-Author: Nothing to Disclose

Symptomatic patients with an intermediate risk of coronary artery disease have a good prognosis if they have a negative myocardial perfusion scan or stress echocardiogram. Recently multi-detector CT coronary angiography has been proposed as an alternative strategy for investigating such patients. As yet the prognostic value of a ‘negative’ coronary CTA is not known

A database search identified 355 symptomatic patients who had undergone coronary CTA as part of routine clinical care, to evaluate possible or known CAD, over a 44-month period up until October 2006. Out of the 355 patients, 179 were identified who firstly had an intermediate risk of CAD following clinical assessment or equivocal stress testing (exercise or perfusion) and secondly a coronary CTA deemed ‘negative’ in view of the absence of a severe coronary artery stenosis (170 with normal coronary arteries / mild coronary artery stenosis and 9 with moderate coronary artery stenosis).

The 179 negative patients had a mean age of 56 years and 102 (57%) were female. Mean duration of patient follow up was 366 days. At follow up all 179 patients were alive and no patients episodes of either MI or UA were identified. In total two revascularisation procedures had subsequently been performed (1.1%), both elective PCI procedures carried out on females from the group of 9 patients with one or more moderate coronary artery stenosis detected at the original coronary CTA.

Approximately 50% of the patients referred for CAD assessment using CCTA were symptomatic intermediate risk chest pain patients who were deemed to have a negative scan. The finding of a negative CCTA in this group of patients appears to confer a good prognosis, at mean follow up of one year, with no deaths and no episodes of UA or MI. The need for subsequent elective PCI procedures in this patient cohort appears very low and confined to the patients with the largest plaque burden. The data suggests that the prognostic value of a negative coronary CTA may be similar to that conferred by a negative myocardial perfusion scan or stress echocardiogram. Larger studies with longer follow are needed to confirm this.

See above

Kakani, N, Vanlingen, R, Veitch, A, Manghat, N, Roobottom, C, Morgan Hughes, G, Can Negative Multidetector Coronary CTA in Symptomatic Patients Confer a Good One Year Prognosis?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5014107.html