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Prognostic value of CTA promising

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Measuring coronary artery disease severity, coronary atherosclerosis and left ventricular ejection fraction with 64-slice cardiac CTA, a modality capable of obtaining all three measures with a single image, had better prognostic and incremental value vs. routine clinical predictors, study findings indicated.

Researchers from Ontario, Canada prospectively enrolled 2,076 consecutive patients who underwent CTA between February 2006 and February 2008. They performed follow-up at six-month intervals for a mean of 16 months to measure all-cause mortality, cardiac death and nonfatal MI.

Data indicated that 31 patients (1.5%) experienced cardiac death or nonfatal MI. All-cause mortality or nonfatal MI was observed in 47 patients (2.3%). Multivariate analysis revealed that CAD severity as measured with CTA predicted major adverse cardiac events (HR=3.02; 95% CI, 1.89-4.83). Furthermore, LVEF demonstrated incremental value (HR=1.47; 95% CI, 1.17-1.86), whereas total plaque score had incremental value over both CAD severity and LVEF for all-cause mortality and nonfatal MI (HR=1.17; 95% CI, 1.06-1.29).

These results of the study support and expand upon previous research that has demonstrated CTA’s prognostic value, measuring major adverse events using LVEF and plaque burden in a large patient population.

“Cardiac CTA seems to be a promising noninvasive modality with prognostic value,” the researchers wrote.

However, because of the single-center, prospective nature of the study, findings may not reflect patient population or physician practices at other centers, the researchers acknowledged. “Large multicenter cohort studies with extended follow-up are still required to fully comprehend the prognostic value of CTA.”

Daniel B. Mark, MD, MPH, and David F. Kong, MD, of Duke University Medical Center in Durham, N.C., called the study noteworthy in an accompanying editorial but noted that whether cardiac CTA will improve clinical outcomes will depend on physician thinking and patient management. “To improve clinical outcomes, a cardiac CTA–based strategy must provide clinicians with actionable information to direct prognosis-modifying treatments efficiently and accurately,” they wrote.

Data from the ongoing PROMISE study, a randomized trial funded by the National Heart, Lung, and Blood Institute, will compare functional stress testing and ≥64-channel cardiac CT in 10,000 low- to intermediate-risk patients. Data from these two trials taken together will help further clarify CTA’s prognostic value, Mark and Kong wrote.

Chow BJW. J Am Coll Cardiol. 2010;55:1017-1028.

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