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CAD as detected by coronary CTA predicted CV events

Bamberg F. J Am Coll Cardiol. 2011;57:2426-2436.

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A new meta-analysis and systematic review has indicated that the presence and extent of coronary artery disease as assessed by coronary CTA is associated with CV events independent of coronary artery calcification and CV risk factors.

“To our knowledge, this is the first study combining available evidence on the predictive value of coronary CTA in a comprehensive analysis of the associated risks and identifying sources of heterogeneity of the existing data,” the researchers wrote. “These data may be particularly relevant to homogenize reporting standards for cardiac CT, to determine appropriate design of prospective randomized trials for risk modification on the basis of cardiac CT findings, and to estimate the potential impact of noninvasive CT imaging on health care systems.”

The analysis included 11 studies identified in a database search that featured a pooled population of 7,335 participants (mean age, 59.1 years) with suspected CAD. Each study followed at least 100 participants for at least 1 year and reported no less than one HR of interest.

Among the nine studies (n=3,670) that provided an HR for the presence of coronary stenosis as determined by coronary CTA, the presence of at least one significant coronary stenosis (>50% diameter stenosis) correlated with an annualized event rate of 11.9% (HR=10.74; 95% CI, 6.37-18.11) or 6.9% (HR=6.15; 95% CI, 3.22-11.74) in studies that excluded revascularization. After adjusting for coronary calcification, the association was not significantly altered (P=.79).

Furthermore, additional estimates of HRs associated with secondary coronary CTA findings included 6.64 for left main stenosis (95% CI, 2.6-17.3) and 4.51 (95% CI, 2.2-9.3) for the presence of plaque.

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