Prognostic value of noninvasive combined anatomic/functional assessment by cardiac CT in patients with suspected coronary artery disease — Comparison with invasive coronary angiography and nuclear myocardial perfusion imaging for the five-year-follow up of the CORE320 multicenter study

Marc Dewey, Carlos E. Rochitte, Mohammad R. Ostovaneh, Marcus Y. Chen, Richard T. George, Hiroyuki Niinuma, Kakuya Kitagawa, Roger Laham, Klaus Kofoed, Cesar Nomura, Hajime Sakuma, Kunihiro Yoshioka, Vishal C. Mehra, Masahiro Jinzaki, Sachio Kuribayashi, Michael Laule, Narinder Paul, Arthur J. Scholte, Rodrigo Cerci, John HoeSwee Yaw Tan, Frank J. Rybicki, Matthew B. Matheson, Andrea L. Vavere, Andrew E. Arai, Julie M. Miller, Christopher Cox, Jeffrey Brinker, Melvin E. Clouse, Marcelo Di Carli, João A.C. Lima, Armin Arbab-Zadeh

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). Methods: At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA within 60 days. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC). Results: Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA-CTP findings compared to ICA-SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: -0.03, 0.36). Abnormal results by combined CTA-CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA-SPECT (95% CI for difference: -0.05, 0.39). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI -4.6, 4.9). When MACE was restricted to cardiovascular death, myocardial infarction, or stroke, AUC for CTA-CTP was 71 vs. 60 by ICA-SPECT (difference 11.2; 95% CI -1.0, 19.7). Conclusions: Combined CTA-CTP evaluation yields at least equal 5-year prognostic information as combined ICA-SPECT assessment in patients presenting with suspected coronary artery disease. Noninvasive cardiac CT assessment may eliminate the need for diagnostic cardiac catheterization in many patients. Clinical trial registration: NCT00934037.

Original languageEnglish
JournalJournal of Cardiovascular Computed Tomography
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • CT angiography
  • Coronary artery disease
  • Coronary atherosclerosis
  • Coronary heart disease
  • Coronary imaging
  • Myocardial perfusion imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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