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A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD.
JACC Cardiovasc Imaging. 2013 Jun; 6(6):641-50.JC

Abstract

OBJECTIVES

The aim of the study was to perform a comparison of the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD).

BACKGROUND

CAD is a major cause of mortality and morbidity, and its management consumes a large proportion of the health care budget. Therefore, identification of patients at high risk of adverse events is crucial. Despite its limited accuracy, ex-ECG is the most commonly used noninvasive test in CAD evaluation. CTA was recently introduced as alternative test.

METHODS

We enrolled 681 patients (age 61.3 ± 10.4 years, 461 men) with atypical or typical angina and no history of CAD. All patients underwent ex-ECG and CTA and were followed for 44 ±12 months. The endpoints were all cardiac events, defined as nonfatal myocardial infarction, cardiac death, and revascularization, and hard cardiac events, defined as all cardiac events excluding revascularization.

RESULTS

ex-ECG and CTA were rated as positive in 419 (61%) and 274 (40%) of 681 patients, respectively. In univariate analysis, both ex-ECG and CTA were predictors of all cardiac events (hazard ratio [HR]: 2.09, 95% confidence interval [CI]: 1.5 to 2.8; p < 0.0001 and HR: 21.1, 95% CI: 14.6 to 30.5; p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% CI: 1.1 to 3.2; p = 0.02 and HR: 6.8, 95% CI: 3.9 to 11.0; p < 0.0001, respectively), whereas in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Stratifying our population by ex-ECG and CTA findings, Kaplan-Meier curves showed that ex-ECG provides only a further risk stratification in the subset of patients with positive findings on CTA and a low to intermediate likelihood of CAD. Moreover, positive findings on CTA identify a shorter event-free period, regardless the ex-ECG findings for both all cardiac events and hard cardiac events, respectively.

CONCLUSIONS

CTA may have a higher prognostic value compared with ex-ECG in patients with suspected CAD, mainly in those with a low to intermediate pre-test likelihood of CAD.

Authors+Show Affiliations

Centro Cardiologico Monzino, IRCCS, Milan, Italy. gianluca.pontone@ccfm.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23764093

Citation

Pontone, Gianluca, et al. "A Long-term Prognostic Value of CT Angiography and Exercise ECG in Patients With Suspected CAD." JACC. Cardiovascular Imaging, vol. 6, no. 6, 2013, pp. 641-50.
Pontone G, Andreini D, Bartorelli AL, et al. A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD. JACC Cardiovasc Imaging. 2013;6(6):641-50.
Pontone, G., Andreini, D., Bartorelli, A. L., Bertella, E., Cortinovis, S., Mushtaq, S., Foti, C., Annoni, A., Formenti, A., Baggiano, A., Conte, E., Bovis, F., Veglia, F., Ballerini, G., Fiorentini, C., Agostoni, P., & Pepi, M. (2013). A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD. JACC. Cardiovascular Imaging, 6(6), 641-50. https://doi.org/10.1016/j.jcmg.2013.01.015
Pontone G, et al. A Long-term Prognostic Value of CT Angiography and Exercise ECG in Patients With Suspected CAD. JACC Cardiovasc Imaging. 2013;6(6):641-50. PubMed PMID: 23764093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD. AU - Pontone,Gianluca, AU - Andreini,Daniele, AU - Bartorelli,Antonio L, AU - Bertella,Erika, AU - Cortinovis,Sarah, AU - Mushtaq,Saima, AU - Foti,Claudia, AU - Annoni,Andrea, AU - Formenti,Alberto, AU - Baggiano,Andrea, AU - Conte,Edoardo, AU - Bovis,Francesca, AU - Veglia,Fabrizio, AU - Ballerini,Giovanni, AU - Fiorentini,Cesare, AU - Agostoni,Piergiuseppe, AU - Pepi,Mauro, PY - 2012/05/07/received PY - 2012/12/31/revised PY - 2013/01/02/accepted PY - 2013/6/15/entrez PY - 2013/6/15/pubmed PY - 2014/1/28/medline SP - 641 EP - 50 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 6 IS - 6 N2 - OBJECTIVES: The aim of the study was to perform a comparison of the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). BACKGROUND: CAD is a major cause of mortality and morbidity, and its management consumes a large proportion of the health care budget. Therefore, identification of patients at high risk of adverse events is crucial. Despite its limited accuracy, ex-ECG is the most commonly used noninvasive test in CAD evaluation. CTA was recently introduced as alternative test. METHODS: We enrolled 681 patients (age 61.3 ± 10.4 years, 461 men) with atypical or typical angina and no history of CAD. All patients underwent ex-ECG and CTA and were followed for 44 ±12 months. The endpoints were all cardiac events, defined as nonfatal myocardial infarction, cardiac death, and revascularization, and hard cardiac events, defined as all cardiac events excluding revascularization. RESULTS: ex-ECG and CTA were rated as positive in 419 (61%) and 274 (40%) of 681 patients, respectively. In univariate analysis, both ex-ECG and CTA were predictors of all cardiac events (hazard ratio [HR]: 2.09, 95% confidence interval [CI]: 1.5 to 2.8; p < 0.0001 and HR: 21.1, 95% CI: 14.6 to 30.5; p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% CI: 1.1 to 3.2; p = 0.02 and HR: 6.8, 95% CI: 3.9 to 11.0; p < 0.0001, respectively), whereas in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Stratifying our population by ex-ECG and CTA findings, Kaplan-Meier curves showed that ex-ECG provides only a further risk stratification in the subset of patients with positive findings on CTA and a low to intermediate likelihood of CAD. Moreover, positive findings on CTA identify a shorter event-free period, regardless the ex-ECG findings for both all cardiac events and hard cardiac events, respectively. CONCLUSIONS: CTA may have a higher prognostic value compared with ex-ECG in patients with suspected CAD, mainly in those with a low to intermediate pre-test likelihood of CAD. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/23764093/A_long_term_prognostic_value_of_CT_angiography_and_exercise_ECG_in_patients_with_suspected_CAD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(13)00339-2 DB - PRIME DP - Unbound Medicine ER -