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

• Published in: European radiology 2017-11, Vol.27 (11), p.4650-4660
• Main Authors: Clerc, Olivier F., Kaufmann, Basil P., Possner, Mathias, Liga, Riccardo, Vontobel, Jan, Mikulicic, Fran, Gräni, Christoph, Benz, Dominik C., Fuchs, Tobias A., Stehli, Julia, Pazhenkottil, Aju P., Gaemperli, Oliver, Kaufmann, Philipp A., Buechel, Ronny R.
• Format: Article
• Language: English
• Subjects: Aged; Angiography; Arteries; Arteriosclerosis; Calcification (ectopic); Calcium; Cardiac; Cardiovascular disease; Computation; Computed tomography; Computed Tomography Angiography - methods; Coronary Angiography - methods; Coronary artery; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary vessels; Diagnostic Radiology; EKG; Electrocardiography; Female; Heart; Humans; Imaging; Internal Medicine; Interventional Radiology; Kaplan-Meier Estimate; Lesions; Male; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Myocardial infarction; Myocardial Infarction - diagnostic imaging; Neuroradiology; Patients; Prognosis; Radiation; Radiation Dosage; Radiology; Reclassification; Regression analysis; Retrospective Studies; Risk Assessment - methods; Severity of Illness Index; Stenosis; Tomography; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-4849-1

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 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.