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

  • Cardiac
  • Published:
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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.

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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

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Acknowledgments

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

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Authors and Affiliations

  1. Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland

    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. Buechel

Authors
  1. Olivier F. Clerc
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  2. Basil P. Kaufmann
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  3. Mathias Possner
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  14. Ronny R. Buechel
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Corresponding author

Correspondence to Ronny R. Buechel.

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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

Additional information

Olivier F. Clerc and Basil P. Kaufmann share first authorship.

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Clerc, O.F., Kaufmann, B.P., Possner, M. et al. Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering. Eur Radiol 27, 4650–4660 (2017). https://doi.org/10.1007/s00330-017-4849-1

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  • DOI: https://doi.org/10.1007/s00330-017-4849-1

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