Coronary artery disease assessed by CCTA predicts prognosis
medwireNews: The extent of coronary artery disease (CAD) determined by coronary computed tomography angiography (CCTA) predicts clinical outcome over the following 3.5 years, irrespective of age, gender, and comorbidity, results of a real-world study suggest.
“These findings emphasize the value of frontline CCTA testing in identifying individuals with CAD, who may benefit from preventive medication in clinical practice,” the researchers write in the European Heart Journal.
Lene Nielsen (Lillebaelt Hospital-Vejle, Denmark) and team found that over a median of 3.57 years of follow-up, the prognostic endpoint – a composite of late coronary revascularization procedure more than 90 days after CCTA, myocardial infarction, and all-cause death – occurred in 1.5% of 9299 patients without CAD, 6.8% of 2737 patients with obstructive CAD, and 15.0% of 240 patients with three-vessel/left main disease.
After adjustment for potential confounding factors including demographics, prior cardiovascular disease, diabetes, and smoking, patients with non-obstructive CAD had a 1.28-fold increase in risk of the composite endpoint compared with those without CAD. Patients with obstructive CAD had a 2.25-fold increased risk, rising to 4.41-fold in those with three vessel/left main obstruction.
In subgroup analyses, increasing severity of CAD was associated with adverse outcomes in all age, gender, and comorbidity categories.
The authors note that although the risk of the composite endpoint “did not differ substantially” between men and women or among patients with different burden of comorbidity, the difference in risk between patients without CAD versus those with obstructive CAD was “more pronounced” among patients aged 55 years or younger compared with older age groups (adjusted HRs= 3.31 for patients aged ≤55 years; 2.22 for those aged 56–65 years, and 1.81 for those aged >65 years).
Furthermore, the inclusion of CAD severity as assessed by CCTA in a model including the Diamond–Forrester risk score and clinical risk factors added “incremental value” for predicting future adverse events, as shown by an increase in the C-index from 0.64 to 0.72.
These findings indicate that “CCTA improved prediction for risk of future events beyond clinical risk assessment,” say the researchers.
And they conclude that the study results “substantiate the real-world use of CCTA testing in patients suspected of CAD.”
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