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Cardiac CTA useful in predicting all-cause mortality in patients with CAD
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Cardiac CTA can incrementally help predict all-cause mortality in symptomatic patients, study results suggested.
Researchers from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, Calif., enrolled 2,538 consecutive patients without known CAD into the study. Patients received an electron beam tomography scan, and the researchers assigned patients to either a normal coronary artery group, mild nonobstructive CAD group or a significant obstructive CAD group. The primary endpoint was all-cause mortality.
There were 86 (3.4%) all-cause deaths during the 78 month follow-up. After adjusting for age, gender, cardiac risk factors and coronary artery calcium, the researchers reported that angiographically significant characteristics of CAD detected by CTA more accurately predicted mortality (area under curve=0.83; 95% CI, 0.77-0.88) compared with traditional risk factor assessment (AUC=0.69; 95% CI, 0.61-0.77). When coronary artery calcification scores were included with the significant CAD detected with CTA, the predictive power increased further (AUC=0.89; 95% CI, 0.86-0.93).
For more information:
- J Am Coll Cardiol. 2008;52:1335-1343.
This is an important study showing for the first time long-term prognostic data on a large series of symptomatic patients undergoing cardiac CTA. The data confirmed angiographic series demonstrating that the greater the number of diseased vessels, the greater the total mortality risk. Importantly, the authors showed that the CTA data were prognostically important even after adjustment for coronary calcification and atherosclerotic risk factors. The equipment used when this patient series was acquired has improved significantly and now allows an even greater visualization of plaque burden than before. The role of cardiac CTA in the evaluation of ambulatory symptomatic patients with suspect cardiac pathology is clearly enhanced by the results of this important paper and could impact the decision or need for cardiac catheterization in some patients.
– Bernard R. Chaitman, MD
Cardiology Today Editorial Board member
The results are impressive and suggest that coronary CTA is a powerful risk stratifier in symptomatic patients. However, there are two caveats. First, the technology used – electron beam coronary CTA – is inferior to current technology for assessment of coronary stenoses in most respects. Thus, the results may differ with more modern 64, 128, 256 or 320 slice multidetector CT. Further, it is important to emphasize that there continues to be no accepted rationale for use of coronary CTA in the asymptomatic patient for risk stratification, and such use of CT is rated inappropriate in the current American College of Cardiology Appropriateness Criteria for CT.
– Nathaniel Reichek, MD
Cardiology Today Editorial Board member