Differential Prognostic Value of Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiography in Asymptomatic Subjects.
10.4250/jcu.2015.23.4.244
- Author:
Sang Eun LEE
1
;
Iksung CHO
;
Geu Ru HONG
;
Hyuk Jae CHANG
;
Ji Min SUNG
;
In Jeong CHO
;
Chi Young SHIM
;
Byoung Wook CHOI
;
Namsik CHUNG
Author Information
1. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. hjchang@yuhs.ac
- Publication Type:Original Article
- Keywords:
Coronary artery disease;
Coronary computed tomography angiography;
Exercise electrocardiography;
Asymptomatic population
- MeSH:
Angina, Unstable;
Angiography*;
Coronary Artery Disease;
Death;
Electrocardiography*;
Follow-Up Studies;
Myocardial Infarction;
Prevalence;
Retrospective Studies;
Risk Factors
- From:Journal of Cardiovascular Ultrasound
2015;23(4):244-252
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects. METHODS: We retrospectively enrolled 812 (59 +/- 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA. RESULTS: The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 +/- 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991). CONCLUSION: CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.
