European Radiology

, Volume 27, Issue 11, pp 4650–4660 | Cite as

Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering

  • Olivier F. Clerc
  • Basil P. Kaufmann
  • Mathias Possner
  • Riccardo Liga
  • Jan Vontobel
  • Fran Mikulicic
  • Christoph Gräni
  • Dominik C. Benz
  • Tobias A. Fuchs
  • Julia Stehli
  • Aju P. Pazhenkottil
  • Oliver Gaemperli
  • Philipp A. Kaufmann
  • Ronny R. BuechelEmail author



To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering.


We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions.


Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001).


Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries.

Key Points

• Coronary CT angiography (CCTA) has an excellent long-term prognostic performance.

• CCTA can accurately stratify cardiac risk according to coronary lesion severity.

• A normal CCTA predicts freedom from cardiac events for >6 years.

• Patients with a coronary calcium score of 0 may experience cardiac events.

• CCTA allows for reclassification of cardiac risk compared with ESC SCORE.


Coronary angiography Multidetector computed tomography Coronary artery disease Event-free survival Prognosis 



Area under the curve


Body mass index


Coronary artery bypass graft


Coronary artery calcium score


Coronary artery disease


Coronary computed tomography angiography


Confidence interval




European Society of Cardiology


Hazard ratio


Interquartile range


Left ventricular ejection fraction


Major adverse cardiac event


Myocardial infarction


Percutaneous coronary intervention


Positron emission tomography


Receiver operating characteristic


Standard deviation


Summed involvement score


Single photon emission computed tomography


Summed severity score



The University Hospital of Zurich holds an institutional research agreement with GE Healthcare. However, this work has received no funding.

Compliance with ethical standards:


The scientific guarantor of this publication is Ronny R. Buechel.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: GE Healthcare. The University Hospital Zurich holds a research agreement with GE Healthcare


The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained. Study subjects or cohorts overlap:

The study population was shared with a previous report on short-term outcome after CCTA (Buechel et al., Heart 2011; 97(17):1385-90).


  • retrospective

  • prognostic study, observational

  • performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Olivier F. Clerc
    • 1
  • Basil P. Kaufmann
    • 1
  • Mathias Possner
    • 1
  • Riccardo Liga
    • 1
  • Jan Vontobel
    • 1
  • Fran Mikulicic
    • 1
  • Christoph Gräni
    • 1
  • Dominik C. Benz
    • 1
  • Tobias A. Fuchs
    • 1
  • Julia Stehli
    • 1
  • Aju P. Pazhenkottil
    • 1
  • Oliver Gaemperli
    • 1
  • Philipp A. Kaufmann
    • 1
  • Ronny R. Buechel
    • 1
    Email author
  1. 1.Cardiac Imaging, Department of Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland

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