Prognostic Value of Multislice Computed Tomography and Gated Single-Photon Emission Computed Tomography in Patients With Suspected Coronary Artery Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:53

Article

van Werkhoven, Jacob M.^1,4  Schuijf, Joanne D.¹  Gaemperli, Oliver^5,6  Jukema, J. Wouter^1,4  Boersma, Eric⁸  Wijns, William⁹  Stolzmann, Paul⁷  Alkadhi, Hatem⁷  Valenta, Ines⁶  Stokkel, Marcel P. M.²  Kroft, Lucia J.³  de Roos, Albert³  Pundziute, Gabija¹  Scholte, Arthur¹  van der Wall, Ernst E.^1,4  Kaufmann, Philipp A.^6,10  Bax, Jeroen J.¹ 

[1] Leiden Univ, Med Ctr, Dept Cardiol, NL-2333 ZA Leiden, Netherlands

[2] Leiden Univ, Med Ctr, Dept Nucl Med, NL-2333 ZA Leiden, Netherlands

[3] Leiden Univ, Med Ctr, Dept Radiol, NL-2333 ZA Leiden, Netherlands

[4] Interuniv Cardiol Inst Netherlands, Utrecht, Netherlands

[5] Univ Zurich Hosp, Dept Cardiol, CH-8091 Zurich, Switzerland

[6] Univ Zurich Hosp, Dept Nucl Med, CH-8091 Zurich, Switzerland

[7] Univ Zurich Hosp, Inst Diagnost Radiol, CH-8091 Zurich, Switzerland

[8] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands

[9] Ctr Cardiovasc, Aalst, Belgium

[10] Univ Zurich, Zurich, Switzerland

关键词: imaging;    atherosclerosis;    perfusion;    prognosis;   

DOI  :  10.1016/j.jacc.2008.10.043

来源: Elsevier

【 摘 要 】

Objectives This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD). Background Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear. Methods In 541 patients (59% male, age 59 +/- 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization. Results In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT >= 50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [ SSS]: >= 4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT >= 50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT >= 50% stenosis). A normal MPI (SSS <4) and abnormal MPI (SSS >= 4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value <0.005). Conclusions MSCT is an independent predictor of events and provides incremental prognostic value to MPI. Combined anatomical and functional assessment may allow improved risk stratification. (J Am Coll Cardiol 2009; 53: 623-32) (C) 2009 by the American College of Cardiology Foundation

【 授权许可】

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