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Major adverse cardiac events can be ruled out by coronary CTA in some patients

Coronary CTA yielded 100% negative predictive value for major adverse cardiac events in patients without atherosclerosis.

Issue: December 2008

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Patients who present with atypical chest pain can have major adverse coronary events ruled out by use of coronary CTA.

Researchers for the study examined 452 consecutive patients (52% female) who had undergone contrast-enhanced coronary CTA using a 64-slice dual-source CT scanner. Stenosis was graded as either mild (>30% stenosis), moderate (between 31% and 50% stenosis) or severe (>50% stenosis). Results of the study were presented at the Radiological Society of North America 94th Scientific Assembly and Annual Meeting in Chicago.

According to the researchers, 254 patients had atherosclerosis at the time of coronary CTA, 87 (33.5%) of whom had severe stenosis >50% at the time of coronary CTA. Severe stenosis was associated with major adverse cardiac events (P=.003), and 26 patients had major adverse cardiac events during the 12-month follow-up. The researchers also reported that 198 patients in the study did not show atherosclerosis at coronary CTA (100% negative predictive value) and that plaque types and calcium scores were not associated with major adverse cardiac event rates (P>.05).

“Coronary CTA can be used to rule out cardiac events within one year in patients without atherosclerosis with a 100% negative predictive value,” Joseph A. Abro, BS, a medical student at the Medical University of South Carolina in Charleston, said. “Coronary CTA has a prognostic value for major adverse cardiac events with intermediate pretest likelihood of CAD. For future applications in the patient with the low-to-medium pretest likelihood of CAD, they could undergo coronary CTA as a means to exclude major adverse cardiac events during follow-up.” – by Eric Raible

For more information:

• Abro J. #SSK02-04. Presented at: Radiological Society of North America 94th Scientific Assembly and Annual Meeting; Nov. 30-Dec 5, 2008; Chicago.

The study appears to involve intermediate-risk patients. It remains uncertain how many participants received another form of testing before CT. Assuming CT is used as a first-line test in these intermediate-risk patients, an advantage of this strategy is that 43% are identified as without CAD. A disadvantage is that 56% may need additional testing to define the functional importance of the coronary artery stenoses. Since the cost of performing multiple tests on 56% of those at intermediate risk is high and this strategy exposes patients to ionizing radiation, one wonders whether a different form of testing may be more suitable for intermediate-risk patients.

– W. Gregory Hundley, MD
Cardiology Today Section Editor