Abstract | OBJECTIVES: This study sought to evaluate the prognostic value of stress dynamic computed tomography (CT) perfusion ( CTP) with CT delayed enhancement (CTDE) in patients with suspected or known coronary artery disease (CAD) and in subgroups of patients with stent, heavy calcification, or stenosis. BACKGROUND: The prognostic value of stress dynamic CTP with CTDE is unknown. METHODS: RESULTS: During a median follow-up of 2.9 years, 43 MACEs occurred. By adding IPD to obstructive CAD (≥50% stenosis) on coronary CT angiography, the concordance index for predicting MACEs increased from 0.73 to 0.82 in patients with suspected CAD (p = 0.028) and from 0.61 to 0.73 in patients with known CAD (p = 0.004). IPD and scar score of ≥4 were independent predictors when adjusted for each other in patients with suspected (adjusted hazard ratios: 7.5 [p < 0.001] and 3.0 [p = 0.034], respectively) or known CAD (adjusted hazard ratios: 4.4 [p = 0.001] and 3.2 [p = 0.024], respectively). Patients with IPD had a higher annualized event rate than those without IPD in subgroups of those with stent (11.5% vs. 2.6%; p < 0.001), heavy calcification (13.3% vs. 3.1%; p < 0.001), 50% to 69% stenosis (8.8% vs. 1.0%; p < 0.001), or ≥70% stenosis (12.4% vs. 3.6%; p < 0.001). CONCLUSIONS: Stress dynamic CTP with CTDE had incremental prognostic value over CT angiography in each group with suspected or known CAD and was prognostically useful in subgroups of patients with stent, heavy calcification, or obstructive CAD. IPD and myocardial scarring may play complementary roles in prognostic stratification.
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Authors | Satoshi Nakamura, Kakuya Kitagawa, Yoshitaka Goto, Masafumi Takafuji, Shiro Nakamori, Tairo Kurita, Kaoru Dohi, Hajime Sakuma |
Journal | JACC. Cardiovascular imaging
(JACC Cardiovasc Imaging)
Vol. 13
Issue 8
Pg. 1721-1734
(08 2020)
ISSN: 1876-7591 [Electronic] United States |
PMID | 32061554
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Coronary Angiography
- Coronary Artery Disease
- Humans
- Myocardial Perfusion Imaging
- Perfusion
- Predictive Value of Tests
- Prognosis
- Tomography, X-Ray Computed
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