Multislice Computed Tomography Coronary Angiography for Risk Stratification in Patients with an Intermediate Pretest Likelihood

OBJECTIVES: To assess whether multislice computed tomography coronary angiography (MSCTA) may be useful for risk stratification of patients with suspected coronary artery disease (CAD) at intermediate pretest likelihood according to Diamond and Forrester. Main Outcome Measures: A combined end point of all-cause mortality, non-fatal infarction and unstable angina requiring revascularisation.

METHOD: MSCTA images were evaluated for the presence of significant CAD in 316 patients with suspected CAD (60% male, average (SD) age 57 (11) years) and an intermediate pretest likelihood according to Diamond and Forrester. Patients were followed up to determine the occurrence of an event.

RESULTS: Significant CAD was seen in 89 patients (28%), whereas normal MSCTA or non-significant CAD was seen in the remaining 227 (72%) patients. During follow-up (median 621 days (25-75th centile 408-835) an event occurred in 13 patients (4.8%). The annualised event rate was 0.8% in patients with normal MSCT, 2.2% in patients with non-significant CAD and 6.5% in patients with significant CAD. Moreover, MSCTA remained a significant predictor (p<0.05) of events after multivariate correction (hazard ratio = 3.460 (95% CI 1.142 to 10.480).

CONCLUSIONS: The results suggest that in patients with an intermediate pretest likelihood, MSCTA is highly effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasise the usefulness of non-invasive imaging with MSCTA in this patient population.

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One Comment

  1. The study analyzed 316 patients with an intermediate pre-test likelihood for CAD showing the capacity of MSCT coronary angiography to identify patients at higher or lower risks for coronary events.
    Although a very interesting study, two relative short-comings in my opinion are that: 1) coronary calcium scores are not reported (especially since there is a high radiation dose associated with CTA); and 2) the plaque composition was not described.

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