Author + information
- Received November 1, 2010
- Revision received December 17, 2010
- Accepted December 20, 2010
- Published online May 1, 2011.
- Christopher L. Schlett, MD⁎,
- Dahlia Banerji, MD⁎,
- Emily Siegel, BA⁎,
- Fabian Bamberg, MD, MPH†,
- Sam J. Lehman, MBBS⁎,
- Maros Ferencik, MD, PhD⁎,‡,
- Thomas J. Brady, MD⁎,
- John T. Nagurney, MD, MPH§,
- Udo Hoffmann, MD, MPH⁎ and
- Quynh A. Truong, MD, MPH⁎,‡,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Quynh A. Truong, Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, Massachusetts 02114
Objectives The aim of this study was to determine the 2-year prognostic value of cardiac computed tomography (CT) for predicting major adverse cardiac events (MACE) in patients presenting to the emergency department (ED) with acute chest pain.
Background CT has high potential for early triage of acute chest pain patients. However, there is a paucity of data regarding the prognostic value of CT in this ED cohort.
Methods We followed 368 patients from the ROMICAT (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial (age 53 ± 12 years; 61% male) who presented to the ED with acute chest pain, negative initial troponin, and a nonischemic electrocardiogram for 2 years. Contrast-enhanced 64-slice CT was obtained during index hospitalization, and caregivers and patients remained blinded to the results. CT was assessed for the presence of plaque, stenosis (>50% luminal narrowing), and left ventricular regional wall motion abnormalities (RWMA). The primary endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization.
Results Follow-up was completed in 333 patients (90.5%) with a median follow-up period of 23 months. At the end of the follow-up period, 25 patients (6.8%) experienced 35 MACE (no cardiac deaths, 12 myocardial infarctions, and 23 revascularizations). Cumulative probability of 2-year MACE increased across CT strata for coronary artery disease (CAD) (no CAD 0%; nonobstructive CAD 4.6%; obstructive CAD 30.3%; log-rank p < 0.0001) and across combined CT strata for CAD and RWMA (no stenosis or RWMA 0.9%; 1 feature—either RWMA [15.0%] or stenosis [10.1%], both stenosis and RWMA 62.4%; log-rank p < 0.0001). The c statistic for predicting MACE was 0.61 for clinical Thrombolysis In Myocardial Infarction risk score and improved to 0.84 by adding CT CAD data and improved further to 0.91 by adding RWMA (both p < 0.0001).
Conclusions CT coronary and functional features predict MACE and have incremental prognostic value beyond clinical risk score in ED patients with acute chest pain. The absence of CAD on CT provides a 2-year MACE-free warranty period, whereas coronary stenosis with RWMA is associated with the highest risk of MACE.
- computed tomography angiography
- coronary artery disease
- emergency department
- long-term outcome
- major adverse cardiac events
This work was supported by the National Institutes of Health (NIH) R01 HL080053 and in part supported by Siemens Medical Solutions and GE Healthcare. Dr. Truong was supported by NIH grants K23HL098370 and L30HL093896. All other authors have reported that they have no relationships to disclose.
- Received November 1, 2010.
- Revision received December 17, 2010.
- Accepted December 20, 2010.
- American College of Cardiology Foundation