Abnormal CT angiography predicts cardiovascular events By Reuters Health June 7, 2011 — NEW YORK (Reuters Health) – The presence and extent of coronary artery disease on computed tomography angiography (CCTA) are strongly predictive of cardiovascular events, researchers report. to view “While to date much research effort has been focused on the diagnostic value of cardiac CTA determining whether there is coronary artery disease or not, we pooled available smaller studies on the prognostic value of cardiac CTA,” Dr. Fabian Bamberg from University of Munich, Germany told Reuters Health in an email. “Interestingly, our data show that findings on cardiac CTA related to the extent of coronary artery disease have very strong prognostic implications for the occurrence of future cardiovascular events.” Dr. Bamberg and colleagues conducted a systematic review and meta-analysis of 11 studies that assessed the prognostic value of CCTA findings on a combined cardiovascular end point. These studies included 7335 patients referred for suspected coronary artery disease. Results appear in the June 14 Journal of the American College of Cardiology. The combined results of nine of these studies revealed a 10.74-fold higher risk of cardiovascular events (all-cause mortality, cardiovascular mortality, nonfatal MI, unstable angina requiring hospitalization, or revascularization) in patients with any detectable coronary stenosis by CCTA, compared with patients without coronary stenosis. This association persisted after adjustment for coronary calcium scoring, but there was significant heterogeneity between studies. Each additional coronary stenosis increased the risk of cardiovascular events by about 35%, the presence of left coronary artery stenosis increased the risk more than sixfold, and the presence of three-vessel disease was associated with a 2.5-fold increased risk. Even the presence of CCTA-detected plaque increased the risk of cardiovascular events about 4.5-fold over that faced by patients without plaque detected. “Cardiac CTA has been a controversial topic since its introduction in the late ’90s,” Dr. Bamberg said. “Much of its controversy it related to associated radiation dose, which has been substantially decreased over the last years. However, this emphasizes the strong need of research data that prove that the technique is superior to other established clinical tools and that the benefit outweighs the associated risks.” “Our data provide risk estimates for all major cardiac CTA findings, which can be used by the caregiving physician and help to optimize lifestyle and treatment options,” Dr. Bamberg concluded. “A fact that we were not able to investigate in sufficient detail was the difference in risk between the different atherosclerotic plaque components, which can be assessed by cardiac CTA,” Dr. Bamberg said. “For instance, it will be of high interest to determine whether noncalcified plaque, a form of plaque that has been associated with the presence of acute coronary syndromes and can be easily measured by CTA, entails a much higher risk for cardiovascular events.” Dr. Bamberg has received grant support from Siemens. By Will Boggs, MD Source: http://bit.ly/m9HzHr J Am Coll Cardiol 2011.