The role of 64-slice multi-detector computed tomography in the detection of subclinical atherosclerosis of the coronary artery.

Abstract

Multi-detector computed tomography (MDCT) has been used for detecting or excluding coronary atherosclerotic stenosis in symptomatic patients. However, the role of MDCT for routine medical examination in asymptomatic, high-risk patients has not been established. We therefore conducted the present study to test the hypothesis that MDCT could be a valuable method for detecting subclinical coronary artery stenosis in asymptomatic patients. An observational, retrospective, single-centre study was conducted with a cohort of 1,529 patients (mean age, 56.4 ± 8.3 years; 1,353 males) who had undergone MDCT as part of their general medical checkups from November 2005 to April 2008. The patients who had a past history of coronary artery disease, typical chest pain, or evidence of myocardial ischemia were excluded. During clinical follow up of these patients, the incidence of subclinical coronary stenosis and the usefulness of MDCT for routine medical examination in asymptomatic patients were investigated. Of the 1,529 enrolled patients, 42.3% had hypertension, 13.5% had diabetes mellitus, 7.7% had hyperlipidemia, and 40.4% were current smokers. Abnormal MDCT findings were noted in 560 (36.6%) patients, who were classified into two groups. One group had the presence coronary calcium with a luminal diameter stenosis of the coronary artery of <50% (n = 508, 33.2%). These patients were treated with medication or clinical follow-up. The other group had a luminal diameter stenosis of the coronary artery of ≥50% with the presence or absence of coronary calcium (n = 52, 3.4%). These patients underwent a conventional coronary angiogram and intravascular ultrasound. A total of 29 of the 1,529 patients (1.9%) presented with insignificant stenosis or myocardial bridge, and 23 patients (1.5%) presented with significant stenosis. The patients with significant stenosis underwent percutaneous coronary intervention (PCI) with stent implantation. Major adverse cardiac events occurred in only 2 patients who had been treated with PCI during a mean follow-up period of 387 ± 253 days. The incidence of significant subclinical coronary stenosis as detected by MDCT in a general medical check-up was 3.4%, and the false-positive rate of MDCT for detecting significant coronary artery stenosis was 55.8% (29/52). 64-Slice MDCT can be a useful tool for noninvasive evaluation of coronary arteries in asymptomatic patients. Further study is needed to clarify the clinical implications of MDCT in general medical check-ups.

• Authors: Hae Chang Jeong, Youngkeun Ahn, Jum Suk Ko, Min Goo Lee, Doo Sun Sim, Keun Ho Park, Nam Sik Yoon, Hyun Ju Youn, Young Joon Hong, Kye Hun Kim, Hyung Wook Park, Ju Han Kim, Yun-Hyeon Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang
• Journal: The international journal of cardiovascular imaging (Int J Cardiovasc Imaging) Vol. 26 Issue Suppl 2 Pg. 253-9 (Dec 2010) ISSN: 1875-8312 [Electronic] United States
• PMID: 20922490 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Angioplasty, Balloon, Coronary (adverse effects, instrumentation)
• Asymptomatic Diseases
• Chi-Square Distribution
• Coronary Angiography (methods)
• Coronary Stenosis (diagnostic imaging, therapy)
• Female
• Humans
• Kaplan-Meier Estimate
• Korea
• Logistic Models
• Male
• Middle Aged
• Predictive Value of Tests
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Stents
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Ultrasonography, Interventional