Association between 64-multislice Coronary Computed Tomography Angiography and Occurrence of Coronary Artery Disease
Date Issued
2009
Date
2009
Author(s)
Kuo, Yen-Shu
Abstract
Background: The diagnostic accuracy of 64-multislice coronary computed tomography angiography (CCTA) regarding obstructive coronary artery disease has been demonstrated in previous studies compared with invasive coronary angiography and intravascular ultrasound. However, the prognostic performance remains to be further examined.bjectives: The study is aimed to assess the association between 64-multislice CCTA and occurrence of major cardiac events or death, and to evaluate the prognostic value of 64-multislice computed tomography coronary angiography compared with the Framingham risk score.aterials and Methods: The study retrospectively enrolled 425 patients who had undergone 64-multislice CCTA at single hospital in Northern Taiwan between May 2006 and December 2007. The severity of coronary atherosclerosis was determined by different CCTA indicators and the occurrence of severe cardiac events (revascularization after 90 days, unstable angina requiring hospitalization, myocardial infarct) or death were observed for mean follow up time of 22 months. The association between severity of coronary atherosclerosis on CCTA and the occurrence of severe cardiac events or death was analyzed using Cox proportional hazard regression model before and after adjustment. The prognostive value of 64-multislice CCTA was evaluated and compared with Framingham risk score using receiver operating characteristic (ROC) curves and area under ROC curves analysis.esults: Increased hazard ratios were observed in cases with more advanced coronary atherosclerosis detected by computed tomography. After adjustment, the hazard ratios were 6.88 (95% confidence interval 1.27-37.25) for modified Duke CAD index 3-6, 6.11 (1.08-34.57) for segment stenosis score > 5, and 5.81 (1.44-23.44) for three-vessel plaque score 1. The hazard ratios were 13.76 (214-88.51) for two-vessel obstructive CAD [≧50% stenosis], 6.08 (1.06-34.81) for obstructive CAD [≧70%], and 8.01 (1.33-48.23) for one-vessel obstructive CAD [≧70%]. Regarding stenosis in proximal and middle segment arteries, the hazard ratios for middle or either proximal or middle segment stenosis [≧50%,≧70%] were 9.84 (2.33-41.66), 13.40 (2.60-69.06), and 6.73 (1.87-24.20) and 8.83 (2.36-33.04), respectively. Further stratification by sex, age, presence of symptoms or diabetes showed significant increase in hazard ratios in the followings: modified Duke CAD index 3-6, three-vessel plaque score 1, two-vessel CAD [≧50%], obstructive CAD [≧70%] and single-vessel CAD [≧70%] in male subgroup; Modified Duke CAD index 3-6, segment stenosis score > 5, three-vessel plaque score 1, two-vessel CAD [≧50%], obstructive CAD [≧70%] and single-vessel CAD [≧70%] in symptomatic subgroup; two-vessel CAD [≧50%] in non-diabetic subgroup.ixty-four multislice CCTA significantly outperformed the Framingham risk score in predicting severe cardiac events and death. Among the CCTA indicators for severity of coronary atherosclerosis, segment stenosis score [either 0-48 or classified into 0, 1-5 and > 5], presence of obstructive CAD [≧50% or ≧70%] and modified Duke CAD index [classified into 0, 1-2, 3-6] were among the best performing indicators with sensitivity approaching 100% and specificity between 81-89%.onclusions: The study demonstrated the positive association between severity of coronary atherosclerosis detected by 64-multislice CCTA and occurrence of severe cardiac events or death, and the outperforming prognostic value of 64-multislice CCTA compared with Framingham risk score.
Subjects
computed tomography
CT angiography
coronary angiography
coronary artery disease
prognosis
SDGs
Type
thesis
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