Chong Fei Y, Soon Kean, Brown Fraser, Bell Kevin, Lim Yean L
Centre for Cardiovascular Therapeutics/Western Radiology, Western Hospital, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2012 Feb;56(1):55-7. doi: 10.1111/j.1754-9485.2011.02332.x.
Coronary CT angiography (CTA) is becoming a popular investigation for chest pain. A negative coronary CTA is known to have a good negative predictive value for major adverse cardiovascular events in short term. The data on the long-term outcomes of negative coronary CTA are lacking. We aim to investigate the long-term prognostic value of negative coronary CTA in the evaluation of chest pain.
This was a retrospective observational study involving 259 cases of coronary CTA on our registry from July 2004 to November 2006. All coronary CTA were performed with GE 16-slice CT and then GE 64-slice CT scanner in late 2006. A negative coronary CTA was defined as no single coronary segment with stenosis ≥50% based on American Heart Association 16-segment model. The end point of the study was defined as a composite of major cardiovascular events such as myocardial infarction, myocardial death or revascularisation.
Seventy cases of 259 on the registry were diagnosed as negative studies. Mean follow-up period was 4.64 ± 0.6 years (range from 3.4 to 5.7 years). Of these negative studies, only one patient suffered from the end point during the follow-up. Thus, the negative predictive value of a negative coronary CTA for a long-term major cardiovascular event was 0.986 (95% confidence interval: 0.92-0.99).
A negative coronary CTA in patients with a low or intermediate pretest probability for significant coronary artery disease predicts a low rate of major cardiovascular events within a 5-year period.
冠状动脉CT血管造影（CTA）正成为一种用于胸痛检查的常用方法。已知冠状动脉CTA阴性对短期主要不良心血管事件具有良好的阴性预测价值。目前缺乏关于冠状动脉CTA阴性的长期预后数据。我们旨在研究冠状动脉CTA阴性在胸痛评估中的长期预后价值。
这是一项回顾性观察性研究，纳入了2004年7月至2006年11月我们登记册上的259例冠状动脉CTA病例。所有冠状动脉CTA均使用GE 16层CT进行，2006年末使用GE 64层CT扫描仪。根据美国心脏协会16段模型，冠状动脉CTA阴性定义为无单个冠状动脉节段狭窄≥50%。研究终点定义为心肌梗死、心源性死亡或血运重建等主要心血管事件的复合终点。
登记册上的259例病例中有70例被诊断为阴性研究。平均随访期为4.64±0.6年（范围为3.4至5.7年）。在这些阴性研究中，随访期间只有1例患者发生了终点事件。因此，冠状动脉CTA阴性对长期主要心血管事件的阴性预测值为0.986（95%置信区间：0.92 - 0.99）。
对于冠状动脉疾病预测试验概率低或中等的患者，冠状动脉CTA阴性预测5年内主要心血管事件发生率较低。
