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Prognostic value of CT angiography in patients with inconclusive functional stress tests
Clerio F de Azevedo1, Marcelo S Hadlich, Sabrina G Bezerra
1D'Or Institute for Research and Education, Rio de Janerio, Brazil. clerio.azevedo@gmail.com
Insights
Coronary computed tomographic angiography (CTA) offers valuable prognostic insights for patients with unclear stress test results. CTA effectively identifies coronary artery disease (CAD) severity, predicting adverse cardiac events beyond traditional risk factors.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Patients with suspected coronary artery disease (CAD) and inconclusive noninvasive cardiac stress tests present a frequent management challenge.
- Accurate risk stratification is crucial for guiding treatment decisions in this population.
Purpose of the Study:
- To determine the prognostic value of coronary computed tomographic angiography (CTA) in patients with inconclusive functional stress tests.
- To assess if coronary CTA provides incremental prognostic information beyond traditional risk factors and coronary artery calcium scores.
Main Methods:
- A cohort of 529 patients with suspected CAD and inconclusive stress tests underwent coronary CTA.
- Coronary CTA assessed CAD severity, categorized into 5 groups from no CAD to severe stenosis (≥70%).
- Survival analyses used Cox proportional hazards models, adjusted for risk factors and calcium scores, with a primary outcome of mortality or myocardial infarction.
Main Results:
- The majority of patients (69%) showed no significant CAD on coronary CTA.
- Increasing degrees of obstructive CAD by CTA independently predicted adverse events (HR: 1.66, p=0.001).
- ≥50% coronary stenosis (HR: 3.15, p=0.01) and the Duke prognostic CAD index (HR: 1.54, p=0.001) were significant predictors of adverse outcomes.
Conclusions:
- Coronary CTA provides incremental prognostic information in patients with inconclusive stress tests.
- Noninvasive assessment of CAD severity by coronary CTA aids in risk stratification beyond traditional factors.
- CTA can help guide management strategies for patients with equivocal stress test results.
Objectives:
We attempted to determine the prognostic value of coronary computed tomographic angiography (CTA) in patients with inconclusive functional stress tests.
Background:
Patients with suspected coronary artery disease (CAD) and inconclusive noninvasive cardiac stress tests represent a frequent management challenge.
Methods:
We examined 529 consecutive patients with suspected CAD and prior inconclusive functional stress tests. All patients underwent a coronary CTA scan using a 64-slice multidetector row scanner. CAD severity by coronary CTA was categorized as: 1) no evidence of CAD; 2) nonobstructive coronary plaques (< 30%); 3) mild stenosis (30% to 49%); 4) moderate stenosis (50% to 69%); and 5) severe stenosis (≥ 70%). Patients were also categorized according to a modified Duke prognostic CAD index. Survival analyses were performed using Cox proportional hazards models adjusted for baseline risk factors and coronary artery calcium score. The primary outcome of the study was the combined endpoint of all-cause mortality and nonfatal myocardial infarction.
Results:
Among patients with inconclusive stress tests, the large majority (69%) did not demonstrate significant CAD by coronary CTA. During a mean follow-up of 30.1 ± 11.1 months, there were 20 (3.8%) deaths and 17 (3.2%) nonfatal myocardial infarctions. Multivariable Cox regression analysis revealed that the presence of increasing degrees of obstructive CAD by CTA was an independent predictor of adverse events (hazard ratio [HR]: 1.66 [95% confidence interval (CI): 1.23 to 2.23], p = 0.001). Indeed, the presence of ≥ 50% coronary stenosis was associated with an increased risk of events (HR: 3.15 [95% CI: 1.26 to 7.89], p = 0.01). Likewise, the Duke prognostic CAD index was also found to be an independent predictor of events (HR: 1.54 [95% CI: 1.20 to 1.97], p = 0.001).
Conclusions:
Among patients with inconclusive functional stress tests, the noninvasive assessment of CAD severity by coronary CTA has been shown to provide incremental prognostic information beyond the evaluation of traditional risk factors and coronary artery calcium score.
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