Prognostic value of coronary computed tomographic angiography in asymptomatic patients

To assess the value of coronary computed tomographic angiography (CCTA) in the prediction of cardiac events in asymptomatic patients, 451 consecutive asymptomatic patients who underwent CCTA from December 2003 to November 2007 were retrospectively analyzed. The primary end point of the study was the occurrence of cardiac events, defined as cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and late revascularization (>90 days after CCTA) during a median follow-up period of 27.5 months. Secondary end points were the prevalence of nonobstructive coronary lesions and the number of patients reclassified regarding their cardiovascular risk. Two hundred twenty-nine patients (54%) had nonobstructive coronary lesions, and 107 patients (24%) obstructive coronary artery disease. During follow-up, there were 2 cases of unstable angina and 8 revascularizations for stable angina. Patients with obstructive coronary artery disease had a significantly higher event rate than those without obstructive CAD (risk ratio 13.9, 95% confidence interval 4.0 to 48.0). In 217 patients (48%), the clinically assessed cardiovascular risk could be reclassified by CCTA from intermediate or high to low risk. In conclusion, although the event rate was low in asymptomatic patients, CCTA could reliably predict further cardiac events and could reclassify 2/3 of patients regarding their cardiovascular risk.