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Published on: August 28, 2018
Differential Prognostic Value of Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiography
Sang-Eun Lee1, Iksung Cho1, Geu-Ru Hong1
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Insights
Coronary computed tomography angiography (CCTA) offers better prediction of major adverse cardiac events than exercise electrocardiography (XECG) in asymptomatic individuals. CCTA is particularly valuable for moderate-to-high-risk patients.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Medicine
Background:
- Assessing the prognostic performance of diagnostic tools in asymptomatic individuals is crucial for early disease detection and intervention.
- Coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) are commonly used non-invasive tests for evaluating coronary artery disease (CAD).
Purpose of the Study:
- To compare the prognostic capabilities of CCTA and XECG in predicting major adverse cardiac events (MACE) in asymptomatic subjects.
- To determine if CCTA provides added prognostic value beyond established risk factors and XECG.
Main Methods:
- Retrospective analysis of 812 asymptomatic subjects who underwent both CCTA and XECG.
- Follow-up for MACE (cardiac death, myocardial infarction, unstable angina, revascularization) over a mean period of 37 months.
- Multivariable Cox-regression and likelihood ratio tests were used to assess independent predictors of MACE.
Main Results:
- The prevalence of occult coronary artery disease (CAD) by CCTA was 17.5%, with 14.8% having positive XECG.
- Nine MACE occurred during follow-up; only CCTA-detected CAD independently predicted MACE (p=0.002).
- CCTA significantly improved risk prediction when added to clinical models (p<0.001) and was prognostic in moderate-to-high-risk individuals (p=0.040).
Conclusions:
- CCTA demonstrates superior prognostic performance compared to XECG in asymptomatic individuals.
- CCTA offers incremental prognostic benefit, especially in moderate-to-high-risk populations identified by the Duke treadmill score.
- XECG can aid in risk stratification to identify asymptomatic patients who may benefit most from CCTA evaluation.
Background:
To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects.
Methods:
We retrospectively enrolled 812 (59 ± 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA.
Results:
The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 ± 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991).
Conclusion:
CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.
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