Prognostic Value of Coronary Computed Tomographic Angiography for Prediction of Cardiac Events in Patients With Suspected Coronary Artery Disease
Prognostic Value of Coronary Computed Tomographic Angiography for Prediction of Cardiac Events in Patients With Suspected Coronary Artery Disease
复制标题
DOI：
10.1016/j.jcmg.2008.11.015
复制
发表时间：
2009-04-01
影响因子：
14
通讯作者：
Hausleiter, Joerg
中科院分区：
文献类型：
--
作者：
Hadamitzky, Martin;Freissmuth, Barbara;Hausleiter, Joerg
我们评估了冠状动脉计算机断层扫描血管造影（CCTA）检测或排除阻塞性冠状动脉疾病（CAD）后的心脏事件发生率。背景一些研究已经证明CCTA检测阻塞性CAD的诊断准确性高于侵入性血管造影，但是关于CCTA临床预后价值的数据有限。256例疑似CAD的连续患者接受了64-前瞻性观察了2004年10月至2006年9月期间在我院进行的CCTA切片中严重心脏事件的发生情况（心脏性死亡、心肌梗死或需要住院治疗的不稳定型心绞痛：主要研究终点）和所有心脏事件（另外包括CCTA后>90天的血运重建）。将观察到的所有心脏事件的发生率与Fragrance风险评分预测的事件发生率进行比较。阻塞性CAD被定义为任何冠状动脉直径狭窄≥ 50%。结果在中位随访18个月（四分位距14 ~ 25个月）期间，严重和所有心脏事件的总发生率分别为0.6%和1.8%。在802例无阻塞性CAD的患者中，有4例心脏事件，其中1例为重度，而在348例阻塞性CAD患者中，有17例心脏事件，其中5例为重度。两组之间严重事件（比值比：17.3，95%置信区间：3.6至82.5）和所有心脏事件（比值比：16.1，95%置信区间：7.2至36.0;均p < 0.001）的差异非常显著。所有心脏事件的发生率在患者无阻塞性CAD是显着低于预测的Fragrance风险评分（p = 0.01）。结论在疑似CAD患者，CCTA有一个显着的预后影响预测心脏事件为随后的18个月。通过CCTA排除梗阻性CAD确定了事件风险低于传统风险因素预测的患者人群。（美国科尔心脏病学杂志2009;2：404-11）（C）2009年美国心脏病学会基金会
OBJECTIVES We assessed the rate of cardiac events after detection or exclusion of obstructive coronary artery disease (CAD) by coronary computed tomography angiography (CCTA). BACKGROUND Several studies have demonstrated a high diagnostic accuracy of CCTA for detection of obstructive CAD compared with invasive angiography, but data regarding the clinical prognostic value of CCTA are limited.METHODS In all, 1,256 consecutive patients with suspected CAD undergoing 64-slice CCTA in our institution between October 2004 and September 2006 were observed prospectively for the occurrence of severe cardiac events (cardiac death, myocardial infarction, or unstable angina requiring hospitalization: primary study end point) and all cardiac events (additionally including revascularization >90 days after CCTA). The observed rate of all cardiac events was compared with the event rate predicted by the Framingham risk score. Obstructive CAD was defined as >= 50% diameter stenosis in any coronary artery.RESULTS During a median follow-up of 18 months (interquartile range 14 to 25 months), the overall rates of severe and all cardiac events were 0.6% and 1.8%, respectively. In 802 patients without obstructive CAD, there were 4 cardiac events, of which 1 was severe, whereas in 348 patients with obstructive CAD, there were 17 cardiac events, of which 5 were severe. The difference between the 2 groups was highly significant both for severe events (odds ratio: 17.3, 95% confidence interval: 3.6 to 82.5) and for all cardiac events (odds ratio: 16.1, 95% confidence interval: 7.2 to 36.0; both p < 0.001). The rate of all cardiac events in patients without obstructive CAD was significantly lower than predicted by the Framingham risk score (p = 0.01).CONCLUSIONS In patients with suspected CAD, CCTA has a significant prognostic impact on the prediction of cardiac events for the subsequent 18 months. The exclusion of obstructive CAD by CCTA identifies a patient population with an event risk lower than predicted by conventional risk factors. (J Am Coll Cardiol Img 2009;2:404-11) (C) 2009 by the American College of Cardiology Foundation