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Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering.

Abstract：

OBJECTIVES:To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. METHODS:We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. RESULTS:Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). CONCLUSION:Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. KEY POINTS:• Coronary CT angiography (CCTA) has an excellent long-term prognostic performance. • CCTA can accurately stratify cardiac risk according to coronary lesion severity. • A normal CCTA predicts freedom from cardiac events for >6 years. • Patients with a coronary calcium score of 0 may experience cardiac events. • CCTA allows for reclassification of cardiac risk compared with ESC SCORE.

journal_name

Eur Radiol

journal_title

European radiology

authors

Clerc OF,Kaufmann BP,Possner M,Liga R,Vontobel J,Mikulicic F,Gräni C,Benz DC,Fuchs TA,Stehli J,Pazhenkottil AP,Gaemperli O,Kaufmann PA,Buechel RR

doi

10.1007/s00330-017-4849-1

subject

Has Abstract

pub_date

2017-11-01 00:00:00

pages

4650-4660

issue

eissn

0938-7994

issn

1432-1084

pii

10.1007/s00330-017-4849-1

journal_volume

pub_type

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Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering.