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Published on: August 28, 2018
Prognostic value of computed tomographic coronary angiography and exercise electrocardiography for cardiovascular
Kye-Hwan Kim1, Kyung Nyeo Jeon2, Min Gyu Kang1
1Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
Insights
Computed tomography coronary angiography (CTCA) better predicts long-term cardiovascular outcomes than exercise electrocardiography (ex-ECG) in patients with chest pain. Combining both tests did not improve predictive accuracy in low- to intermediate-risk populations.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Chest pain is a common symptom requiring accurate diagnosis of coronary artery disease (CAD).
- Exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) are non-invasive diagnostic tools.
- Head-to-head comparison of their long-term prognostic values is crucial for clinical decision-making.
Purpose of the Study:
- To compare the predictive values of ex-ECG and CTCA for long-term cardiovascular outcomes.
- To evaluate the added prognostic value of combining ex-ECG and CTCA in patients presenting with chest pain.
Main Methods:
- A cohort of 442 patients with chest pain underwent both ex-ECG and CTCA.
- ex-ECG parameters included Duke treadmill score (DTS).
- CTCA parameters included coronary artery calcium score (CACS), plaque presence, and coronary stenosis severity. Cardiovascular events were tracked for 2.8 years.
Main Results:
- Coronary stenosis ≥ 50% (HR 7.426) was the only significant independent predictor of cardiovascular events in Cox regression.
- CTCA parameters like CACS > 40, plaque presence, and coronary stenosis ≥ 50% showed significant odds ratios.
- Adding DTS ≤ 4 to coronary stenosis ≥ 50% did not significantly improve prediction models.
Conclusions:
- CTCA demonstrates superior predictive value for long-term cardiovascular outcomes compared to ex-ECG in low- to intermediate-risk patients with chest pain.
- The combination of CTCA and ex-ECG does not offer superior prognostic information beyond CTCA alone.
Background/Aims:
This study is a head-to-head comparison of predictive values for long-term cardiovascular outcomes between exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) in patients with chest pain.
Methods:
Four hundred and forty-two patients (mean age, 56.1 years; men, 61.3%) who underwent both ex-ECG and CTCA for evaluation of chest pain were included. For ex-ECG parameters, the patients were classified according to negative or positive results, and Duke treadmill score (DTS). Coronary artery calcium score (CACS), presence of plaque, and coronary artery stenosis were evaluated as CTCA parameters. Cardiovascular events for prognostic evaluation were defined as unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death.
Results:
The mean follow-up duration was 2.8 ± 1.1 years. Fifteen patients experienced cardiovascular events. Based on pretest probability, the low- and intermediate-risks of coronary artery disease were 94.6%. Odds ratio of CACS > 40, presence of plaque, coronary stenosis ≥ 50% and DTS ≤ 4 were significant (3.79, p = 0.012; 9.54, p = 0.030; 6.99, p < 0.001; and 4.58, p = 0.008, respectively). In the Cox regression model, coronary stenosis ≥ 50% (hazard ratio, 7.426; 95% confidence interval, 2.685 to 20.525) was only significant. After adding DTS ≤ 4 to coronary stenosis ≥ 50%, the integrated discrimination improvement and net reclassification improvement analyses did not show significant.
Conclusions:
CTCA was better than ex-ECG in terms of predicting long-term outcomes in low- to intermediate-risk populations. The predictive value of the combination of CTCA and ex-ECG was not superior to that of CTCA alone.
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