Prognostic value of noninvasive combined anatomic/functional assessment by cardiac CT in patients with suspected coronary artery disease - Comparison with invasive coronary angiography and nuclear myocardial perfusion imaging for the five-year-follow up of the CORE320 multicenter study.

Abstract

BACKGROUND:

Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT).

METHODS:

At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC).

RESULTS:

Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7).

CONCLUSIONS:

Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients.

CLINICAL TRIAL REGISTRATION:

NCT00934037.

• Authors: Marc Dewey, Carlos E Rochitte, Mohammad R Ostovaneh, Marcus Y Chen, Richard T George, Hiroyuki Niinuma, Kakuya Kitagawa, Roger Laham, Klaus Kofoed, Cesar Nomura, Hajime Sakuma, Kunihiro Yoshioka, Vishal C Mehra, Masahiro Jinzaki, Sachio Kuribayashi, Michael Laule, Narinder Paul, Arthur J Scholte, Rodrigo Cerci, John Hoe, Swee Yaw Tan, Frank J Rybicki, Matthew B Matheson, Andrea L Vavere, Andrew E Arai, Julie M Miller, Christopher Cox, Jeffrey Brinker, Melvin E Clouse, Marcelo Di Carli, João A C Lima, Armin Arbab-Zadeh
• Journal: Journal of cardiovascular computed tomography (J Cardiovasc Comput Tomogr) 2021 Nov-Dec Vol. 15 Issue 6 Pg. 485-491 ISSN: 1876-861X [Electronic] United States
• PMID: 34024757 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2021 Society of Cardiovascular Computed Tomography. All rights reserved.

Topics

• Computed Tomography Angiography
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging)
• Follow-Up Studies
• Humans
• Myocardial Perfusion Imaging
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Tomography, X-Ray Computed