J Cardiovasc Ultrasound.  2015 Dec;23(4):244-252. 10.4250/jcu.2015.23.4.244.

Differential Prognostic Value of Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiography in Asymptomatic Subjects

• Lee SE
• Cho I
• Hong GR
• Chang HJ
• Sung JM
• Cho IJ
• Shim CY
• Choi BW
• Chung N

• KMID: 2144455
• DOI: http://doi.org/10.4250/jcu.2015.23.4.244

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.

Keyword

Coronary artery disease; Coronary computed tomography angiography; Exercise electrocardiography; Asymptomatic population

MeSH Terms

Angina, Unstable
Angiography*
Coronary Artery Disease
Death
Electrocardiography*
Follow-Up Studies
Myocardial Infarction
Prevalence
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Kaplan-Meier survival curve of the MACE free survival according to results of XECG (A), risk stratification with DTS (B), and the presence of CAD on CCTA (C). MACE: major adverse cardiac events, XECG: exercise electrocardiography, DTS: Duke treadmill score, CAD: coronary artery disease, CCTA: coronary computed tomography angiography.

• 

  Fig. 2 Cox proportional hazard regression analysis for major adverse cardiac events according to the presence of CAD by CCTA in low risk group (A) and moderate to high risk group (B) classified with DTS - adjusted with age, gender, hypertension, diabetes mellitus, dyslipidemia, and current smoking. CAD: coronary artery disease, CCTA: coronary computed tomography angiography, DTS: Duke treadmill score.

• 

  Fig. 3 Time-dependent ROC curve analysis for prediction of MACE in moderate risk group classified with Duke treadmill score according to clinical risk factor model (solid line) and clinical risk factor plus CAD on CCTA model (dashed line). AUC: area under curve, CAD: coronary artery disease, CCTA: coronary computed tomography angiography, MACE: major adverse cardiac event, ROC: receiver operating characteristic.

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