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01-11-2017 | Cardiac

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

Authors: Olivier F. Clerc, Basil P. Kaufmann, Mathias Possner, Riccardo Liga, Jan Vontobel, Fran Mikulicic, Christoph Gräni, Dominik C. Benz, Tobias A. Fuchs, Julia Stehli, Aju P. Pazhenkottil, Oliver Gaemperli, Philipp A. Kaufmann, Ronny R. Buechel

Published in: European Radiology | Issue 11/2017

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.

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Title: Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering
Authors: Olivier F. Clerc
Basil P. Kaufmann
Mathias Possner
Riccardo Liga
Jan Vontobel
Fran Mikulicic
Christoph Gräni
Dominik C. Benz
Tobias A. Fuchs
Julia Stehli
Aju P. Pazhenkottil
Oliver Gaemperli
Philipp A. Kaufmann
Ronny R. Buechel
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 11/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4849-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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