Author + information
- Received May 8, 2018
- Revision received July 10, 2018
- Accepted July 23, 2018
- Published online October 17, 2018.
- Tom Finck, MDa,
- Julius Hardenberg, MDa,
- Albrecht Will, MDa,
- Eva Hendrich, MDa,
- Bernhard Haller, PhDb,
- Stefan Martinoff, MDa,
- Jörg Hausleiter, MDc and
- Martin Hadamitzky, MDa,∗ ()
- aInstitut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Munich, Germany
- bInstitut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar der Technische Universität München, Munich, Germany
- cMedizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
- ↵∗Address for correspondence:
Priv.-Doz. Dr. med. Martin Hadamitzky, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany.
Objectives The aim of this study was to determine the long-term prognostic power of coronary computed tomography angiography (CTA) to predict cardiac death and nonfatal myocardial infarction.
Background Prognostic usefulness of coronary CTA has been confirmed for short- and intermediate-term follow-up. However, long-term data for prognostic usefulness is still lacking, but is paramount because of the slowly progressing nature of coronary artery disease (CAD).
Methods A total of 2,011 patients with suspected but not previously diagnosed CAD were examined by coronary CTA. Mean follow-up was 10.0 years (interquartile range [IQR]: 8.1 to 11.2 years). Cox proportional hazards analysis was used for the composite endpoint of cardiac death and nonfatal myocardial infarction. Event-free survival, which was defined as the years it took to reach a cumulative 1% risk for the composite endpoint and reclassification from clinical risk, was calculated.
Results The study endpoint was reached in 58 patients (42 cardiac deaths, 16 nonfatal myocardial infarctions). Coronary CTA-assessed CAD severity (normal, nonobstructive, or obstructive) showed the best correlation with the endpoint, with an adjusted c-index of 0.704, compared with a univariate c-index of 0.622 for the clinical risk model (Morise score) alone. The annual event rate for patients with normal coronary arteries on baseline coronary CTA was 0.04%, which translated to an event-free survival period of 10 years. The highest annual event rate of 1.33% was found in patients with 3-vessel obstructive CAD. Reclassification from clinical risk (Morise score) was possible in approximately two-thirds of all patients (68%; p < 0.0001), which led to a substantial reduction of the intermediate-risk group (reduction from 74% to 15%) in favor of the low-risk group (increase from 20% to 83%).
Conclusions Patients with normal coronary CTA results benefitted from an event-free survival period of 10 years against cardiac death and nonfatal myocardial infarction. Risk stratification according to coronary CTA results allowed for the delineation of clearly diverging prognostic groups and reclassified approximately two-thirds of all patients from clinical risk groups.
- coronary artery disease
- coronary computed tomographic angiography
- event-free survival
Dr. Hausleiter has received speaker honoraria and research support from Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 8, 2018.
- Revision received July 10, 2018.
- Accepted July 23, 2018.
- 2018 American College of Cardiology Foundation
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