Filippo Cademartiri MD, PhD, Abstract Co-Author: Nothing to Disclose

Anselmo Alessandro Palumbo MD, Abstract Co-Author: Nothing to Disclose

Michele Fusaro MD, Abstract Co-Author: Nothing to Disclose

Erica Maffei MD, Presenter: Nothing to Disclose

Valerio Brambilla MD, Abstract Co-Author: Nothing to Disclose

Annachiara Aldrovandi MD, Abstract Co-Author: Nothing to Disclose

Multislice computed tomography coronary angiography (CTCA) allows detection of coronary lesions with high diagnostic accuracy and has a high negative predictive value for excluding coronary artery disease (CAD) compared to coronary angiography. However the prognostic value of MSCT is unknown. The aim of this study was to determine the predictive value of CTCA for major cardiac events in patients with suspected coronary artery disease (CAD).

A total of 187 patients (119 men, age 62.5 ± 10.5 years) without known heart disease and clinical suspicion of CAD underwent 64-slice CTCA (Somatom Sensation 64, Siemens). Patients were followed up at 2 years for the occurrence of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and cardiac revascularization.

On a total of 2822 coronary segments, 42 (1.5%) were non evaluable because of motion artefacts. Mean cardiac frequency during the MSCT exam was 62.5 ± 10.2 bpm. In 65 (34.7%) patients CTCA showed complete absence of coronary artery atherosclerosis, in 87 (46.5%) patients CTCA detected non obstructive coronary plaques (coronary plaque ≤50%), in 35 (18.8%) patients CTCA detected obstructive coronary lesions (>50%). During the follow-up, a total of 23 major cardiac events occurred (3 myocardial infarction, 19 cardiac revascularization, 1 admission for unstable angina). 1 non cardiac death occurred. In patients with normal coronary arteries at CTCA, the event rate was 0%. Of the patients with non obstructive CAD, 3 underwent cardiac revascularization for unstable angina. Of the patients with obstructive CAD, 3 had myocardial infarction, 16 patients had cardiac revascularization and 1 patient had documented unstable angina but coronary anatomy was deemed not amenable to revascularization.

CT-CA demonstrates a 100% negative predictive value for major cardiac events at 24 months follow-up in patients with normal coronary arteries. Cardiac event rate increases with CAD severity and is higher in patients with obstructive disease on CTCA.

Predictive value of CT-CA at 2 years follow-up: major adverse cardiac event rate increases with CAD severity.

Cademartiri, F, Palumbo, A, Fusaro, M, Maffei, E, Brambilla, V, Aldrovandi, A, Prognostic Value of Coronary Computed Tomography in Patients with Suspected Coronary Artery Disease in a Large Prospective Single Center Experience with 2 Years' Follow-up.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5016607.html