Budoff Matthew J, Bloom Stephen A, Chow Benjamin J W, Chandler Arthur B, Cole Jason H
aDavid Geffen School of Medicine, Harbor-UCLA Medical Center, Division of Cardiology, Los Angeles Biomedical Research Institute, Los Angeles, California bOverland Park, Kansas cDepartment of Medicine, University Health Care System, Augusta, Georgia dMobile, Alabama, USA eDepartment of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Coron Artery Dis. 2015 Jun;26(4):301-7. doi: 10.1097/MCA.0000000000000248.
To evaluate the diagnostic performance and predictive value of coronary computed tomography angiography (CCTA) on subsequent cardiac outcomes.
CCTA has been suggested as an alternative method to invasive coronary angiography for detection of and ruling out coronary artery disease (CAD). However, the usefulness of CCTA findings in predicting patient outcome in routine clinical practice is still uncertain.
A prospective, multicenter registry study of CCTA with a Visipaque injection 320 mg I/ml was carried out in symptomatic patients suspected of having CAD as part of their medical care. CCTA findings were used to guide patient management decisions. Patient cardiac outcomes were followed at 1, 6, and 12 months after the CCTA procedure for the occurrence of major adverse cardiac event (MACE) (cardiac death, nonfatal myocardial infarction, or unstable angina requiring hospitalization). All cardiac outcome events or deaths were adjudicated independently.
Of 874 patients (mean age=59 years; 51% men) who received Visipaque, 857 were included in the efficacy analysis. Using cardiac outcomes as the endpoint, the sensitivity of CCTA was 96.1, 95.8, and 94.7%, specificity was 84.5, 86.6, and 87.0%, and negative predictive value more than 99.0% at 1, 6, and 12 months, respectively. At 12 months, the rate of MACE was 5.7% (10/174) in patients with a positive CCTA (one or more ≥50% stenosis) and 0.1% (1/683) in patients with a negative CCTA (99.9% MACE-free survival rate). The Cox proportional hazards analysis with CCTA outcome, age, sex, reasons for CCTA, and cardiac risk factors as covariates showed a hazard ratio of 87.6 for positive versus negative CCTA (P=0.0001).
CCTA is a highly accurate, noninvasive tool to detect or rule out subsequent cardiovascular events in patients with intermediate pretest probability of CAD or an uninterpretable/equivocal stress test. A positive CCTA finding contributed significantly toward the prediction of subsequent MACE whereas a negative CCTA carried excellent prognostic outcomes at 12 months.
评估冠状动脉计算机断层扫描血管造影（CCTA）对后续心脏结局的诊断性能和预测价值。
CCTA已被建议作为一种替代侵入性冠状动脉造影的方法，用于检测和排除冠状动脉疾病（CAD）。然而，在常规临床实践中，CCTA检查结果在预测患者预后方面的实用性仍不确定。
对怀疑患有CAD的有症状患者进行了一项前瞻性、多中心登记研究，使用碘克沙醇注射液320mgI/ml进行CCTA检查，该检查作为其医疗护理的一部分。CCTA检查结果用于指导患者管理决策。在CCTA检查后的1、6和12个月，对患者的心脏结局进行随访，观察主要不良心脏事件（MACE）（心脏死亡、非致命性心肌梗死或需要住院治疗的不稳定型心绞痛）的发生情况。所有心脏结局事件或死亡均由独立人员判定。
在874例接受碘克沙醇检查的患者（平均年龄=59岁；51%为男性）中，857例纳入疗效分析。以心脏结局为终点，CCTA在1、6和12个月时的敏感性分别为96.1%、95.8%和94.7%，特异性分别为84.5%、86.6%和87.0%，阴性预测值均超过99.0%。在12个月时，CCTA检查结果阳性（一处或多处≥50%狭窄）的患者中MACE发生率为5.7%（10/174），CCTA检查结果阴性的患者中MACE发生率为0.1%（1/683）（无MACE生存率为99.9%）。以CCTA检查结果、年龄、性别、CCTA检查原因和心脏危险因素作为协变量的Cox比例风险分析显示，CCTA检查结果阳性与阴性相比，风险比为87.6（P=0.0001）。
对于CAD预检概率中等或应激试验结果无法解释/不明确的患者，CCTA是一种高度准确的非侵入性工具，可用于检测或排除后续心血管事件。CCTA检查结果阳性对后续MACE的预测有显著贡献，而CCTA检查结果阴性在12个月时具有良好的预后结局。
