Abstract
Purpose
The aim of the study was to assess the prognostic value of multidetector-row CT coronary angiography (MDCT-CA) in patients with suspected coronary artery disease (CAD) in a routine clinical context.
Materials and methods
A total of 125 patients (82 men, age 57.4±10.3 years) with suspected CAD underwent MDCT-CA. All patients were assessed for cardiovascular risk factors, symptoms and coronary calcium score. A 2-year follow-up study for the occurrence of major adverse cardiac events was performed.
Results
According to the Morise pretest score, 76 patients (60.8%) were at intermediate risk. Patients with suspected CAD presented the following prognostic outcome (p<0.0001): in 41 patients with normal coronary arteries at MDCT-CA, the event rate was 0%; five of 49 patients with nonobstructive CAD had major cardiac events; two of 35 patients with obstructive CAD suffered cardiac death and 19 underwent revascularisation. At multivariate analysis, the presence of obstructive CAD is the only significant independent prognostic variable (hazard ratio, 10.1393; 95% confidence interval 3.2189–31.9379; p<0.0001).
Conclusions
Routine clinical MDCT-CA provides an excellent prognostic value at 2-year follow-up in patients with normal coronary arteries. The cardiac event rate increases with CAD severity.
Riassunto
Obiettivo
Scopo del nostro lavoro è stato quello di definire il valore prognostico della angiografia coronarica mediante tomografia computerizzata multistrato (AC-TCMS) in pazienti con sospetta malattia aterosclerotica coronarica (MAC) nella routine clinica.
Materiali e metodi
Centoventicinque pazienti (82 uomini, età media 57,4±10,3 anni) con sospetta MAC sottoposti ad AC-TCMS sono stati inclusi in un follow-up a 2 anni per eventi cardiaci maggiori. È stata effettuata una valutazione dei fattori di rischio, della sintomatologia ed una quantificazione del calcio coronarico.
Risultati
Sulla base del Morise pre-test score, 76 pazienti (60,8%) presentano rischio intermedio. I pazienti presentano il seguente outcome prognostico (p<0,0001): nessun evento in 41 pazienti con coronarie normali alla AC-TCMS; 5 eventi cardiaci maggiori fra i 49 pazienti con MAC non ostruttiva; 2 morti cardiache e 19 rivascolarizzazioni fra i 35 pazienti con MAC ostruttiva. La presenza di MAC ostruttiva è l’unica variabile prognostica indipendente significativa messa in evidenza dall’analisi multivariata (hazard ratio 10,1393, 95% intervallo di confidenza 3,2189–31,9379, p<0,0001).
Conclusioni
Nella routine clinica la AC-TCMS presenta un eccellente valore prognostico a 2 anni in caso di coronarie normali. Il numero di eventi cardiaci maggiori aumenta con la severità della patologia riscontrata.
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La Grutta, L., Runza, G., Gentile, G. et al. Prognostic outcome of routine clinical noninvasive multidetector-row computed tomography coronary angiography in patients with suspected coronary artery disease: a 2-year follow-up study. Radiol med 116, 521–531 (2011). https://doi.org/10.1007/s11547-011-0655-z
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DOI: https://doi.org/10.1007/s11547-011-0655-z