Long-term prognostic value of coronary computed tomography angiography in chest pain patients

Area of Science:

• Cardiology
• Radiology
• Preventive Medicine

Background:

• Coronary computed tomography angiography (CCTA) is increasingly utilized for diagnosing coronary artery disease (CAD).
• Long-term prognostic data following CCTA remain limited, necessitating further research.
• Understanding the long-term outcomes associated with varying degrees of CAD detected by CCTA is crucial for patient management.

Purpose of the Study:

• To assess the prognostic capability of CCTA in individuals with suspected CAD.
• To determine the long-term risk of major adverse cardiac events (MACE) based on CCTA findings.
• To evaluate the independent predictive value of different CAD severities on future cardiac events.

Main Methods:

• A cohort of 1205 patients undergoing CCTA for chest pain was analyzed.
• Patients were categorized into three groups: normal coronary arteries, non-obstructive CAD, and obstructive CAD.
• The primary endpoint was MACE, encompassing cardiac death, myocardial infarction, unstable angina, and late revascularization, with a median follow-up of 3.1 years (7.5 years total).

Main Results:

• Over 7.5 years, MACE occurred in 1.0% of patients with normal arteries, 4.6% with non-obstructive CAD, and 20.7% with obstructive CAD.
• Significant differences in MACE rates were observed between normal and non-obstructive CAD (P=0.023) and normal and obstructive CAD (P<0.001).
• Multivariable analysis confirmed non-obstructive CAD (HR 3.22, P=0.041) and obstructive CAD (HR 25.18, P<0.001) as independent predictors of MACE.

Conclusions:

• Patients with normal coronary arteries exhibit an excellent long-term prognosis.
• The risk of MACE escalates with the presence and severity of coronary artery disease (non-obstructive and obstructive).
• Both non-obstructive and obstructive CAD identified by CCTA are independently associated with an increased risk of future ischemic events.