Chayanopparat Punyanuch, Pischart Kittithach, Wanitchung Kasinee, Prechawuttidech Sumet, Kaolawanich Yodying
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Medicine (Baltimore). 2025 Mar 14;104(11):e41901. doi: 10.1097/MD.0000000000041901.
Exercise stress testing (EST) remains effective in assessing coronary artery disease (CAD), especially in developing countries, while coronary computed tomography angiography (CCTA) is being increasingly utilized. However, limited data exist on whether CCTA following EST can affect diagnosis or treatment. This study aimed to characterize patients who underwent CCTA following EST and evaluate its clinical impact. Consecutive patients who underwent CCTA after EST for CAD assessment between 2014 and 2021 were included in the study. CCTA results were categorized as obstructive CAD, nonobstructive CAD, and normal. Clinical and EST characteristics were compared among groups. Multivariable logistic regression analysis was used to identify independent predictors of obstructive CAD. The diagnostic impact and therapeutic consequences of CCTA were assessed at the subsequent clinic visits. A total of 209 patients (64% male, age 60 ± 10 years) with 26% known CAD were included. The most common indication for CCTA was an inconclusive EST (31%). CCTA revealed obstructive CAD in 53 patients, nonobstructive CAD in 111 patients, and normal results in 45 patients. Multivariable analysis identified hyperlipidemia (odds ratio 3.60, 95% confidence interval 1.27-10.22, P = .01) and the Duke Treadmill Score (odds ratio 0.86, 95% confidence interval 0.80-0.92, P < .001) as independent predictors of obstructive CAD. CCTA had a diagnostic impact on 69% of all patients (76% for patients with no known CAD and 50% for patients with known CAD), including the exclusion of obstructive CAD in patients with a positive EST; the diagnosis of obstructive CAD, nonobstructive CAD, or normal CCTA in patients with an inconclusive EST; and the diagnosis of both obstructive and nonobstructive CAD in patients with a negative EST. Therapeutically, CCTA led to medication changes in 38% of patients, while 24% underwent invasive procedures. In conclusion, among patients undergoing CCTA following EST for CAD assessment, hyperlipidemia and the Duke Treadmill Score were identified as independent predictors of obstructive CAD. CCTA also had significant diagnostic and therapeutic impacts in this population.
运动负荷试验（EST）在评估冠状动脉疾病（CAD）方面仍然有效，尤其是在发展中国家，而冠状动脉计算机断层扫描血管造影（CCTA）的应用越来越广泛。然而，关于EST后进行CCTA是否会影响诊断或治疗的数据有限。本研究旨在描述EST后接受CCTA的患者特征，并评估其临床影响。本研究纳入了2014年至2021年间因CAD评估在EST后接受CCTA的连续患者。CCTA结果分为阻塞性CAD、非阻塞性CAD和正常。比较各组的临床和EST特征。采用多变量逻辑回归分析确定阻塞性CAD的独立预测因素。在随后的门诊就诊时评估CCTA的诊断影响和治疗结果。共纳入209例患者（男性占64%，年龄60±10岁），其中26%患有已知CAD。CCTA最常见的指征是EST结果不确定（31%）。CCTA显示53例患者为阻塞性CAD，111例患者为非阻塞性CAD，45例患者结果正常。多变量分析确定高脂血症（比值比3.60，95%置信区间1.27 - 10.22，P = 0.01）和杜克运动平板评分（比值比0.86，95%置信区间0.80 - 0.92，P < 0.001）为阻塞性CAD的独立预测因素。CCTA对所有患者中的69%有诊断影响（无已知CAD的患者为76%，有已知CAD的患者为50%），包括排除EST阳性患者的阻塞性CAD；确定EST结果不确定患者的阻塞性CAD、非阻塞性CAD或CCTA正常；以及确定EST阴性患者的阻塞性和非阻塞性CAD。在治疗方面，CCTA导致38%的患者药物改变，而24%的患者接受了侵入性操作。总之，在因CAD评估在EST后接受CCTA的患者中，高脂血症和杜克运动平板评分被确定为阻塞性CAD的独立预测因素。CCTA在该人群中也有显著的诊断和治疗影响。
