CT angiography uncovers cardiovascular disease risk

Feb 25 2013

By Lynda Williams, Senior medwireNews Reporter

Computed tomography (CT) angiography can warn of the likelihood for major adverse cardiovascular events (MACEs) in patients suspected of having coronary artery disease (CAD) in the absence of medically modifiable risk factors, research shows.

"CCTA should be considered as an appropriate first- line test for patients with atypical chest pain and suspected but not confirmed [CAD]," commented lead author, Jonathon Leipsic (University of British Columbia, Vancouver, Canada) in a press release.

The study examined the ability of CT angiography to identify CAD and stratify the risk for MACE in 5262 patients with chest pain or a family history of CAD but no diabetes mellitus, hypertension, dyslipidemia, or smoking.

The results revealed a dose-response relationship between the number of vessels with obstructive CAD and the risk for MACE over an average of 2.3 years of follow-up. Specifically, patients with one vessel with 50% or greater obstruction had a hazard ratio (HR) for MACE of 6.11 compared with no obstruction. There was a HR of 5.86 for two vessels, rising to a HR of 11.69 for three vessels or the left main vessel.

Maximal stenosis severity in the individual patient also significantly predicted the risk for MACE, with a HR of 1.74 for nonobstructive CAD and 6.64 for obstructive CAD, after adjusting for age and gender.

The increased risk for MACE with CT-detected CAD was true for both symptomatic and asymptomatic patients, with HRs of 11.9 and 6.3, respectively.

The annual rate of MACE among patients with no CAD detected at CT angiography was 0.31% compared with 2.06% for patients with obstructive disease, Leipsic et al report in Radiology.

"The results of the present study support the use of anatomic imaging with coronary CT angiography as a potentially effective method to discriminate individuals who do versus do not have CAD and who may benefit from more intensive medical and/or interventional therapy," they conclude.

"Future prospective therapeutic studies will be useful in this regard and, on the basis of the current findings, now appear warranted."

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