Increasing CAD detected by cardiac CTA escalated CV event risk

Hulten E. J Am Coll Cardiol. 2011;doi:10.1016/j.jacc.2010.10.011.

Issue: January 2011

Researchers of a study appearing in the Journal of the American College of Cardiology found a direct relationship between increasing coronary artery disease detected via cardiac CTA and an increasing risk for major adverse CV events, including death.

“Although the diagnostic accuracy of cardiac CTA has been reported in [more than] 50 studies and meta-analyses, the prognostic value of cardiac CTA for predicting clinical events is less defined. Our systematic review and meta-analysis is the first comprehensive analysis of multiple recent longitudinal studies describing the prognostic value of cardiac CTA,” the researchers wrote. “We have shown that the absence of CAD on cardiac CTA conveys an excellent prognosis for symptomatic patients being evaluated for suspected CAD.”

In the study, researchers searched databases for longitudinal studies of cardiac CTA that included at least 3 months of follow-up and reported major adverse CV events, including death, MI and revascularization. All patients (n=9,592) had suspected CAD and were compiled from 18 studies.

After a median follow-up of 20 months, the pooled annualized event rate for major adverse CV events for obstructive cardiac CTA — defined as any vessel with more than 50% luminal stenosis — was higher than for normal CTA (8.8% vs. 0.17%; P<.05), as was the event rate for death or MI (3.2% vs. 0.15%; P<.05). The pooled negative likelihood ratio for major adverse CV events after normal cardiac CTA findings was 0.008 (P<.001), 1.70 for the positive likelihood ratio (P<.001), 0.99 for sensitivity (P<.001) and 0.41 for specificity (P<.001).

Additionally, there were incremental increases to adverse events when researchers stratified by no CAD, obstructive CAD and nonobstructive CAD, the latter defined as worst stenosis less than 50%.

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