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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
Cardiac

Abstract

Objectives

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

Methods

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.

Results

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).

Conclusion

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.

Keywords

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

Abbreviations

AUC

Area under the curve

BMI

Body mass index

CABG

Coronary artery bypass graft

CACS

Coronary artery calcium score

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

CI

Confidence interval

ECG

Electrocardiogram

ESC

European Society of Cardiology

HR

Hazard ratio

IQR

Interquartile range

LVEF

Left ventricular ejection fraction

MACE

Major adverse cardiac event

MI

Myocardial infarction

PCI

Percutaneous coronary intervention

PET

Positron emission tomography

ROC

Receiver operating characteristic

SD

Standard deviation

SIS

Summed involvement score

SPECT

Single photon emission computed tomography

SSS

Summed severity score

Notes

Acknowledgments

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

Compliance with ethical standards:

Guarantor

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

Funding

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).

Methodology

  • 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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