Review

The International Journal of Cardiovascular Imaging

, Volume 27, Issue 3, pp 413-420

First online:

Prognostic value of absence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography A systematic review and meta-analysis

  • Jawdat AbdullaAffiliated withDivision of Cardiology, Department of Medicine, Glostrup University Hospital Email author 
  • , Camilla AsfergAffiliated withDivision of Cardiology, Department of Medicine, Glostrup University Hospital
  • , Klaus Fuglsang KofoedAffiliated withDepartment of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen

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Abstract

To determine via a meta-analysis the prognostic value of 64-slice computed tomography angiography (CTA) by quantifying risk of major adverse cardiac events (MACE) in different patient groups classified according to CT angiographic findings. A systematic literature search and meta-analyses was conducted on 10 studies examining stable, symptomatic and intermediate risk patients by 64-slice CTA. Patients were followed up for a mean of 21 month. Patient groups with CT-angiographic non-obstructive (stenosis <50% of luminal narrowing) or obstructive (stenosis ≥50% of luminal narrowing) CAD were compared to those having normal angiography without CAD. MACE (cardiac death, non-fatal myocardial infarction and revascularization) numbers were used to calculate odds ratios (OR) with 95% confidence interval (CI) in each group. Ten studies including 5,675 patients were eligible for meta-analysis. The cumulative MACE rate over 21 months were 0.5% in patients with normal CTA, 3.5% in non-obstructive CAD and 16% in obstructive CAD. Compared to normal CTA, non-obstructive CAD was associated with significant increased risk of MACE with OR = 6.68 (3.01–14.82 CI 95%), P = 0.0001. Obstructive CAD was associated with further significant increased risk of MACE with OR = 41.19 (22.56–75.18, CI 95%), P = 0.0001. The studies were homogenous, P-value >0.05 for heterogeneity. 64-slice CTA is able to differentiate low-risk from high-risk patients with suspected or known CAD. Absence of CAD predicts excellent prognosis, while obstructive CAD is associated with markedly increased risk of MACE.

Keywords

Computed tomography Coronary angiography Prognosis Risk stratification