Predictive and prognostic value of 256-slice computed tomography angiography in patients with suspected coronary artery diseases

Abstract

Background: Coronary computed tomography angiography (CCTA) is commonly used to diagnose coronary artery diseases (CADs). We aimed to determine the utility of CCTA among patients suspected with CAD at the Prince Sultan Cardiac Center Qassim. Materials and Methods: CCTA results of 425 cardiac patients, complaining of chest pain with suspected CAD, were used to classify coronary artery stenosis into two types: obstructive if the luminal stenosis was ≥50% or nonobstructive if it was <50%. Followups were conducted through clinic or phonebased interviews to document any of the following endpoints: nonfatal myocardial infarctions (MIs) or cardiac deaths (CDs), representing the major cardiac events. All other cardiac cases, including hospitalization with unstable angina, and/or late coronary revascularization, were documented. Results: Patients with a normal coronary artery were 278 (65.5%). The number of patients with nonobstructive and obstructive diseases was 85 (20%) and 62 (14.5%), respectively. After 19.6 ± 7 months of followup, 21 cardiac events occurred in twenty patients: five major adverse events (two CDs and three nonfatal MIs), ten hospitalizations due to unstable angina, and six late coronary revascularizations. Furthermore, the cumulative allcardiacevent rates in patients with normal coronary arteries, nonobstructive CAD, and obstructive CAD were 3 (1%), 7 (8.2%), and 11 (17.7%), respectively. However, patients with normal CCTA had no major cardiac events during the followup. Conclusion: CCTA can provide valuable prognostic information on patients with suspected CAD. Patients are likely to have excellent intermediate outcomes if the coronary arteries are confirmed to be normal by CCTA.

Keywords

Angiography - coronary artery - prognosis

Publication History

Article published online:
09 August 2021

• References

• 1 World Health Organization , The World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: World Health Organization; 2002
• 2 Ho WK, Hankey GJ, Eikelboom JW. Prevention of coronary heart disease with aspirin and clopidogrel: Efficacy, safety, costs and costeffectiveness. Expert Opin Pharmacother 2004; 5: 493-503
• 3 Collins R, Armitage J, Parish S, Peto R. Heart Protection Study Collaborative Group. et al MRC/BHF heart protection study of cholesterollowering with simvastatin in 5963 people with diabetes: A randomised placebocontrolled trial. Lancet 2003; 361: 2005-16
• 4 Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E. et al. Diagnostic performance of 64multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: Results from the prospective multicenter ACCURACY (Assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 2008; 52: 1724-32
• 5 AlMallah MH, Aljizeeri A, Villines TC, Srichai MB, Aljizeeri A. Cardiac computed tomography in current cardiology guidelines. J Cardiovasc Comput Tomogr 2015; 9: 514-23
• 6 Al-Mallah MH, Qureshi W, Pantelic M, Nour K. Long term prognostic value of Coronary Computed Tomography Angiography in suspected coronary artery disease: a 62 month median follow-up study. International journal of cardiology 2014; 176: 1244-6
• 7 van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W. et al. Prognostic value of multislice computed tomography and gated singlephoton emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 2009; 53: 623-32
• 8 Shaw LJ, Berman DS, Hendel RC, Borges Neto S, Min JK, Callister TQ. et al. Prognosis by coronary computed tomographic angiography: Matched comparison with myocardial perfusion singlephoton emission computed tomography. J Cardiovasc Comput Tomogr 2008; 2: 93-101
• 9 Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS. et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975; 51: 5-40
• 10 Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ. et al. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 2009; 3: 122-36
• 11 Abazid RM, Smettei OA, Khalaf HH, Soomro T, Ali Dar M, Tamim M. et al. The role of computed tomographic angiography in predicting left anterior descending artery graftability when catheter angiography is inconclusive. J Thorac Imaging 2018; 33: 55-9
• 12 Opolski MP. Cardiac computed tomography for planning revascularization procedures. J Thorac Imaging 2018; 33: 35-54
• 13 Andreini D, Pontone G, Mushtaq S, Bartorelli AL, Bertella E, Antonioli L. et al. A longterm prognostic value of coronary CT angiography in suspected coronary artery disease. JACC Cardiovasc Imaging 2012; 5: 609-701
• 14 Hadamitzky M, Achenbach S, AlMallah M, Berman D, Budoff M, Cademartiri F. et al. Optimized prognostic score for coronary computed tomographic angiography: Results from the CONFIRM registry (COronary CT angiography evaluatioN for clinical outcomes: An inteRnational multicenter registry). J Am Coll Cardiol 2013; 62: 468-76
• 15 Hou ZH, Lu B, Gao Y, Jiang SL, Wang Y, Li W. et al. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC Cardiovasc Imaging 2012; 5: 990-9