Coronary tomography for predicting adverse events in patients with suspected coronary disease

Although studies have demonstrated a high diagnostic accuracy of multi-detector Coronary CT (MDCT) in the detection of Coronary Artery Disease (CAD), data on the prognostic value of this method are limited.

Determine the value of MDCT in predicting adverse clinical outcomes in patients with suspected CAD.

We prospectively evaluated 355 consecutive patients (mean age 58 ± 12 years, 252 males) with suspected CAD between January 2008 and June 2010. CAD at MDCT was defined as the presence of atheromatous plaque observed in any coronary artery. The adverse clinical outcomes were defined as death, myocardial infarction, unstable angina or myocardial revascularization.

During a mean follow-up of 15 months, there were 55 cardiac events. In the multivariate analysis using the Cox regression model, NYHA functional class, diabetes, smoking and atherosclerosis at the MDCT were predictors of adverse clinical outcome, and the presence of plaque at the MDCT was strongly associated with adverse clinical outcomes, regardless of established risk factors for CAD (hazard ratio 5.29; 95% confidence interval: 2.4 -11.8, p <0.001).

The presence of atherosclerosis demonstrated by MDCT in patients with suspected CAD showed independent and incremental value when compared to conventional risk factors in the prediction of adverse clinical outcomes, and may prove useful in risk stratification of these patients.