Prognostic Value of Multislice Computed Tomography and Gated Single-Photon Emission Computed Tomography in Patients With Suspected Coronary Artery Disease

JM van Werkhoven, JD Schuijf, O Gaemperli, JW Jukema, Eric Boersma, W (William) Wijns, P Stolzmann, H Alkadhi, I Valenta, MPM Stokkel, LJ Kroft, A de Roos, G Pundziute, A Scholte, EE van der Wall, PA Kaufmann, JJ Bax

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Abstract

Objectives This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD). Background Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear. Methods In 541 patients (59% male, age 59 +/- 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization. Results In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT >= 50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [ SSS]: >= 4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT >= 50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT >= 50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS >= 4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005). Conclusions MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification. (J Am Coll Cardiol 2009; 53: 623-32) (C) 2009 by the American College of Cardiology Foundation
Original languageUndefined/Unknown
Pages (from-to)623-632
Number of pages10
JournalJournal of the American College of Cardiology
Volume53
Issue number7
DOIs
Publication statusPublished - 2009

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