Gianluca Pontone MD, Presenter: Nothing to Disclose

Daniele Andreini MD, Abstract Co-Author: Nothing to Disclose

Erika Bertella, Abstract Co-Author: Nothing to Disclose

Sarah Cortinovis, Abstract Co-Author: Nothing to Disclose

Andrea Daniele Annoni MD, Abstract Co-Author: Nothing to Disclose

Saima Mushtaq, Abstract Co-Author: Nothing to Disclose

Andrea Baggiano, Abstract Co-Author: Nothing to Disclose

Edoardo Conte, Abstract Co-Author: Nothing to Disclose

Alberto Formenti, Abstract Co-Author: Nothing to Disclose

Giovanni Ballerini, Abstract Co-Author: Nothing to Disclose

Cesare Fiorentini MD, Abstract Co-Author: Nothing to Disclose

Mauro Pepi, Abstract Co-Author: Nothing to Disclose

The aim of the study is to perform a comparison of the prognostic performance of MDCT vs. ex-ECG in patients with suspected coronary artery disease (CAD).

681 patients (61.3±10.4 year, 461 men) with chest pain and no history of CAD performed ex- ECG and MDCT and were followed-up for 44±12 months. The endpoints were "all cardiac events", defined as unstable angina, myocardial infarction, cardiac death and revascularization, and "hard cardiac events", defined as all cardiac events excluding revascularization.

Ex-ECG and MDCT were positive in 419 (61%) and 274 (40%) out of 681 patients, respectively. Myocardial infarction, unstable angina, revascularization and cardiac death occurred in 31 (4%), 31 (4%), 178 (26%), 11 (2%) and annual rate of all and hard cardiac events were 10% and 3%, respectively. In univariate analysis, both ex-ECG and MDCT were predictors of all cardiac events (HR:2.09 [1.5-2.8], p<0.0001 and HR:21.1 [14.6-30.5], p<0.0001, respectively) and hard cardiac events (HR:1.8 [1.1-3.2], p=0.02 and HR:6.8 [3.9-12.0], p<0.0001, respectively), while in a multivariate analysis CAD with 50% stenoses detected by MDCT was the only independent predictor of hard cardiac events (HR:2.7 [1.2-6.0], p<0.01). Kaplan-Meier curves (Figure 1) for hard cardiac events in patients with a negative both ex-ECG and MDCT (A), positive ex-ECG and negative MDCT (B), negative ex-ECG and positive MDCT (C) and positive both ex-ECG and MDCT (D) showed that ex-ECG provides a further and better risk stratification only in patients with low to intermediate pre-test likelihood of CAD and positive MDCT

A higher prognostic value of MDCT as compared to ex-ECG was found in patients with suspected CAD, mainly in those with a low-to-intermediate pre-test likelihood of CAD

Evaluation of coronary anatomy with MDCT may be the first diagnostic tool needed for prognostic stratification of patients with a low to intermediate pre-test likelihood of CAD

Pontone, G, Andreini, D, Bertella, E, Cortinovis, S, Annoni, A, Mushtaq, S, Baggiano, A, Conte, E, Formenti, A, Ballerini, G, Fiorentini, C, Pepi, M, Comparison of Multidetector Computed Tomography Coronary Angiography (MDCT) and Exercise Electrocardiography (ex-ECG) for Prognostic Stratification of Patients with Suspected Coronary Artery Disease.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12033494.html