Coronary CT angiography predicts mortality

Multidetector coronary CT angiography predicts all-cause mortality

NEW YORK (Reuters Health), Sep 20 – Multidetector coronary computed tomographic angiography (CCTA) in patients with chest symptoms reliably identifies increased risk of all-cause mortality, according to a report in the September 18th Journal of the American College of Cardiology.

“One major criticism of the use of current generation 64-detector-row CT of the coronary arteries is the lack of outcomes evidence,” Dr. James K. Min told Reuters Health. “Our study represents the first, hopefully, of many that will validate the clinical utility of cardiac CT angiography.”

Dr. Min from Weill Medical College of Cornell University, New York Presbyterian Hospital, and colleagues investigated whether CCTA provided incremental prognostic value for prediction of all-cause mortality in 1127 patients with chest symptoms (pain, tightness, palpitations, or dyspnea).

Patients who died during a mean follow-up of 15 months had significantly higher CCTA-visualized coronary stenosis in the left main coronary artery and the proximal portions of other coronary arteries, the authors report.

In multivariable analysis, plaque in increasing numbers of coronary arteries, moderate and severe plaque, and plaque in the left main artery were all independent predictors of all-cause mortality.

The negative predictive values for all-cause mortality were high for the absence of any plaque (99.7%), the absence of left main plaque (97.8%), and the absence of plaque in the proximal left anterior descending artery (98.4%).

“We know from prior studies that the diagnostic accuracy of current generation 64-row CT scanners is high,” Dr. Min said. “Our study represents the first large study that demonstrates that CCTA can effectively stratify risk of individuals above and beyond traditional risk factor scoring. This characteristic makes CCTA much more valuable, as we can effectively intensify medical and interventional therapy in those who need it most.”

“CCTA appears to be most valuable in the low and intermediate pretest risk population, while for individuals with high pretest risk of significant coronary artery disease, functional testing by nuclear SPECT imaging appears most valuable,” Dr. Min explained.

“The future of CCTA will be decided by its incremental value within the current imaging armamentarium,” writes Dr. John H. Mahmarian from Methodist DeBakey Heart Center, Houston, in a related editorial.

“It may well be that selectively combining CCTA with function assessments of ischemia will further streamline patient care and improve outcomes,” Dr. Mahmarian concludes. “These answers will become apparent only through prospective multicenter clinical trials.”

By Will Boggs, M.D.

Last Updated: 2007-09-19 14:53:33 -0400 (Reuters Health)

J Am Coll Cardiol 2007;50:1161-1170,1171-1173