Prognostic value of coronary CTA vs. exercise treadmilltesting: results from the Partners registry

被引:17
作者
Cheezum, Michael K. [1 ,2 ]
Subramaniyam, Prem Srinivas [3 ]
Bittencourt, Marcio S. [1 ,2 ,4 ]
Hulten, Edward A. [1 ,2 ,5 ,6 ]
Ghoshhajra, Brian B. [4 ]
Shah, Nishant R. [1 ,2 ]
Forman, Daniel E. [1 ,2 ]
Hainer, Jon [1 ,2 ]
Leavitt, Marcia [3 ]
Padmanabhan, Ram [3 ]
Skali, Hicham [1 ,2 ]
Dorbala, Sharmila [1 ,2 ]
Hoffmann, Udo [7 ]
Abbara, Suhny [8 ]
Di Carli, Marcelo F. [1 ,2 ]
Gewirtz, Henry [3 ]
Blankstein, Ron [1 ,2 ]
机构
[1] Harvard Univ, Brigham & Womens Hosp, Dept Med,Sch Med, Noninvas Cardiovasc Imaging Program,Cardiovasc Di, Boston, MA 02115 USA
[2] Harvard Univ, Brigham & Womens Hosp, Dept Radiol,Sch Med, Noninvas Cardiovasc Imaging Program,Cardiovasc Di, Boston, MA 02115 USA
[3] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Dept Med,Div Cardiol, Boston, MA 02115 USA
[4] Univ Sao Paulo, Div Internal Med, Ctr Clin & Epidemiol Res, Sao Paulo, Brazil
[5] Walter Reed Natl Mil Med Ctr, Div Med, Serv Cardiol, Bethesda, MD USA
[6] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA
[7] Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Radiol, Boston, MA 02115 USA
[8] Univ Texas SW Med Ctr Dallas, Dept Radiol, Dallas, TX 75390 USA
关键词
exercise testing; coronary computed tomographic angiography; prognosis; major adverse cardiac events; coronary artery disease; COMPUTED-TOMOGRAPHY ANGIOGRAPHY; INTERNATIONAL MULTICENTER REGISTRY; STABLE ANGINA-PECTORIS; ISCHEMIC-HEART-DISEASE; ARTERY-DISEASE; CHEST-PAIN; CARDIAC CT; MYOCARDIAL-INFARCTION; EXTRACARDIAC FINDINGS; CLINICAL-OUTCOMES;
D O I
10.1093/ehjci/jev087
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims We sought to compare the complementary prognostic value of exercise treadmill testing (ETT) and coronary computed tomographic angiography (CTA) among patients referred for both exams. Methods and results We studied 582 patients without known coronary artery disease (CAD) who were clinically referred for ETT and CTA within 6 months. Patients were followed for cardiovascular (CV) death, non-fatal myocardial infarction (MI), or late revascularization (. 90 days), stratified by Duke Treadmill Score (DTS) and CAD severity (>= 50% stenosis). Mean age was 54 +/- 13 years (63% male). In median follow-up of 40 months, there were 3 CV deaths, 7 non-fatal MIs, and 26 late revascularizations. ETT was inconclusive in 23%, positive in 31%, and negative in 46%. CTA demonstrated no CAD in 37%, non-obstructive CAD in 28%, and obstructive CAD in 35%. Among low-risk ETT patients (n = 326), there were 3 MI, 10 late revascularizations, and the frequent presence of non-obstructive (32%, n = 105) and obstructive CAD (27%, n = 88). When present, ETT features (i.e. angina, DTS, ischaemic electrocardiogram changes, and exercise capacity) individually failed to predict CV death/MI after adjustment for Morise score. Conversely, both obstructive CAD [HR 4.9 (1.0-23.3), P = 0.048] and CAD extent by segment involvement score >4 [HR 3.9 (1.0-15.2), P = 0.049] predicted increased risk for CV death or MI. Conclusion Patients with a low-risk ETT have an excellent prognosis at 40 months, despite the frequent presence of non-obstructive (32%) and obstructive (27%) CAD. In patients with an intermediate-to high-risk ETT (DTS,5), CTA can provide incremental risk stratification for future CV events.
引用
收藏
页码:1338 / 1346
页数:9
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