SEMPTOMATİK HASTALARDA İNVAZİV KORONER ANJİYOGRAFİ İLE KARŞILAŞTIRILDIĞINDA KORONER BİLGİSAYARLI TOMOGRAFİK ANJİYOGRAFİNİN TANISAL PERFORMANSI: UZUN DÖNEM PROGNOSTİK ETKİLER

Abstract

Amaç: Bu araştırmada, stabil semptomatik hastalarda 64 çok-kesitli koroner bilgisayarlı tomografik anjiyografinin (ÇKBTA) tanısal doğruluğu ile koroner arter hastalığı (KAH) ciddiyeti, kardiyovasküler risk skorları ve koroner kalsiyum skoru (KKS) arasındaki ilişkiyi incelemek amaçlanmıştır. Ayrıca, ortalama 10 yıllık takipte, tüm nedenlere bağlı mortalitenin olası prediktörlerini değerlendirdik.
Gereç ve Yöntem: Bu retrospektif, gözlemsel çalışmaya, şüpheli KAH olan ve iki hafta içinde ÇKBTA ve invaziv koroner anjiyografi yapılmış 45 hasta dahil edildi (%67 erkek, ortalama yaş 62,1±10,72 yıl). Duyarlılık, özgüllük, pozitif ve negatif kestirim değerleri (PKD ve NKD), ÇKBTA için segment ve hasta bazlı analizde hesaplandı. Toplam KKS (Agatston units [AU]) ve sistematik koroner risk değerlendirme (SCORE) skorları her hasta için hesaplandı.
Bulgular: Segment ve hasta bazlı analizde, ÇKBTA’nın NKD ve PKD sırasıyla %97 ve %100, ve %94 ve %88 idi. KKS >100 AU olan grup daha yüksek ciddi KAH insidansı ile ilişkili bulundu (OR=4,88, 95% CI 1,62–14,68 p<0,001). KKS ile SCORE risk değerleri arasında önemli pozitif korelasyon mevcuttu (r=0,669, p<0,001). Takipte, 6 (%13,3) hasta öldü. KKS, SCORE risk değeri ve yaş birlikte, ortalama 10 yıllık takipte tüm nedenlere bağlı ölüm tahminini önemli ölçüde iyileştirdi (AUC=0,833, 95% CI 0,693–0,974, p=0,009).
Sonuç: 64-ÇKBTA, ciddi KAH’ı dışlamak veya belirlemek için yüksek tanısal doğruluğa sahiptir. Ayrıca, KKS ve SCORE risk skoru uzun dönem mortaliteyi öngörmek ve koruyucu tedavileri iyileştirmek için değerli prognostik bilgiler sağlayabilir.

Keywords

• çok kesitli bilgisayarlı tomografik anjiyografi
• koroner arter hastalığı
• mortalite
• kardiyovasküler risk

Project Number

Ethics committee Decision no: 1086, Approval no: 1103

THE DIAGNOSTIC PERFORMANCE OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY COMPARED WITH INVASIVE CORONARY ANGIOGRAPHY IN SYMPTOMATIC PATIENTS: LONG–TERM PROGNOSTIC IMPLICATIONS

Abstract

Objective: We aimed to investigate the diagnostic accuracy of 64-multidetector coronary computed tomographic angiography (CCTA) for stable symptomatic patients and evaluate the relationship between severity of coronary artery disease (CAD), cardiovascular risk scores, and coronary artery calcium (CAC) scores. We also assessed the possible predictors of all-cause mortality at a median of 10 years of follow-up.
Materials and Methods: This retrospective, observational study included 45 patients with suspected CAD who had undergone CCTA and invasive coronary angiography within the previous two weeks (67% male, mean age 62.1±10.72 years). Using CCTA, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated on a segment and patient basis analysis. The total CAC (Agatston units [AU]) and systematic coronary risk evaluation (SCORE) scores were calculated for each patient.
Results: The CCTA NPV and PPV for the segment- and patient-based analyses were 97% and 100%, and 94% and 88%, respectively. CAC scores >100 AU reflected a higher incidence of significant CAD (OR=4.88, 95% CI 1.62–14.68 p<0.001), and CAC scores were significantly correlated with SCORE risk values (r=0.669, p<0.001). Ultimately, 6 patients (13.3%) died. Combined CAC and SCORE value and age significantly improved the prediction of all-cause mortality at a median of 10 years of follow-up (AUC=0.833, 95% CI 0.693–0.974, p=0.009).
Conclusion: 64-multidetector CCTA has high diagnostic accuracy for detecting or excluding significant CAD. Moreover, CAC and SCORE risk score may provide valuable prognostic information for predicting long-term mortality and improving preventive therapies.

Keywords

• Multidetector computed tomography angiography
• coronary artery disease
• mortality
• cardiovascular risk

Supporting Institution

NONE

Project Number

Ethics committee Decision no: 1086, Approval no: 1103

Thanks

The authors thank Scribendi Editing Services for editing in English.

References

1. 1. Azevedo CF, Rochitte CE, Lima JA. Coronary artery calcium score and coronary computed tomographic angiography for cardiovascular risk stratification. Arq Bras Cardiol 2012;98(6):559-68. [CrossRef] google scholar
2. 2. Noto TJ, Jr, Johnson LW, Krone R, Weaver WF, Clark DA, Kramer JR, Jr. et al. Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). Cathet Cardiovasc Diagn 1991;24(2):75-83. [CrossRef] google scholar
3. 3. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008;52(21):1724-32. [CrossRef] google scholar
4. 4. Petcherski O, Gaspar T, Halon DA, Peled N, Jaffe R, Molnar R, et al. Diagnostic accuracy of 256-row computed tomographic angiography for detection of obstructive coronary artery disease using invasive quantitative coronary angiography as reference standard. Am J Cardiol 2013;111(4):510-5. [CrossRef] google scholar
5. 5. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359(22):2324-36. [CrossRef] google scholar
6. 6. Leber AW, Becker A, Knez A, von Ziegler F, Sirol M, Nikolaou K, et al. Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 2006;47(3):672-7. [CrossRef] google scholar
7. 7. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006;114(16):1761-91. [CrossRef] google scholar
8. 8. Schneer S, Bachar GN, Atar E, Koronowski R, Dicker D. Evaluation of framingham and systematic coronary risk evaluation scores by coronary computed tomographic angiography in asymptomatic adults. Am J Cardiol 2013;111(5):700-4. [CrossRef] google scholar

9. 9. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975;51(4 Suppl):5-40. [CrossRef] google scholar
10. 10. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37(29):2315-81. [CrossRef] google scholar
11. 11. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al. European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2003;10(4):S1-10. [CrossRef] google scholar
12. 12. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119(3):480-6. [CrossRef] google scholar
13. 13. Williams MC, Hunter A, Shah ASV, Assi V, Lewis S, Smith J, et al. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease. J Am Coll Cardiol 2016;67(15):1759-68. [CrossRef] google scholar
14. 14. Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, de Feyter P, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J 2008;29(4):531-56. [CrossRef] google scholar
15. 15. Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 2015;372(14):1291-300. [CrossRef] google scholar
16. 16. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/ SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: J Am Coll Cardiol 2006;48(7):1475-97. [CrossRef] google scholar
17. 17. Gray AJ, Roobottom C, Smith JE, Goodacre S, Oatey K, O’Brien R, et al. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. Bmj 2021;374:n2106. [CrossRef] google scholar
18. 18. Linde JJ, Kelb^k H, Hansen TF, Sigvardsen PE, Torp-Pedersen C, Bech J, et al. Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2020;75(5):453-63. [CrossRef] google scholar
19. 19. Chinnaiyan KM, Raff GL, Goraya T, Ananthasubramaniam K, Gallagher MJ, Abidov A, et al. Coronary computed tomography angiography after stress testing: results from a multicenter, statewide registry, ACIC (Advanced Cardiovascular Imaging Consortium). J Am Coll Cardiol 2012;59(7):688-95. [CrossRef] google scholar
20. 20. Mancini GBJ, Leipsic J, Budoff MJ, Hague CJ, Min JK, Stevens SR, et al. CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial. JACC Cardiovasc Imaging 2021;14(7):1384-93. [CrossRef] google scholar
21. 21. Dewey M, Rief M, Martus P, Kendziora B, Feger S, Dreger H, et al. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial. Bmj 2016;355:i5441. [CrossRef] google scholar
22. 22. Chang HJ, Lin FY, Gebow D, An HY, Andreini D, Bathina R, et al. Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD: A Randomized, Controlled, Open-Label Trial. JACC Cardiovasc Imaging 2019;12(7 Pt 2):1303-12. [CrossRef] google scholar
23. 23. Rudzinski PN, Kruk M, Demkow M, Oleksiak A, Schoepf JU, Mach M, et al. Efficacy and safety of coronary computed tomography angiography in patients with a high clinical likelihood of obstructive coronary artery disease. Kardiol Pol 2022;80(1):56-63. [CrossRef] google scholar
24. 24. Ramjattan NA, Lala V, Kousa O, Makaryus AN. Coronary CT Angiography. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022. google scholar
25. 25. Tridandapani S, Banait-Deshmane S, Aziz MU, Bhatti P, Singh SP. Coronary computed tomographic angiography: A review of the techniques, protocols, pitfalls, and radiation dose. J Med Imaging Radiat Sci 2021;52(3s):S1-S11. [CrossRef] google scholar
26. 26. Springer I, Dewey M. Comparison of multislice computed tomography with intravascular ultrasound for detection and characterization of coronary artery plaques: a systematic review. Eur J Radiol 2009;71(2):275-82. [CrossRef] google scholar
27. 27. LaBounty TM, Devereux RB, Lin FY, Weinsaft JW, Min JK. Impact of coronary computed tomographic angiography findings on the medical treatment and control of coronary artery disease and its risk factors. Am J Cardiol 2009;104(7):873-7. [CrossRef] google scholar
28. 28. Cheezum MK, Hulten EA, Smith RM, Taylor AJ, Kircher J, Surry L, et al. Changes in preventive medical therapies and CV risk factors after CT angiography. JACC Cardiovasc Imaging 2013;6(5):574-81. [CrossRef] google scholar
29. 29. Emami H, Takx RAP, Mayrhofer T, Janjua S, Park J, Pursnani A, et al. Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of Statin Therapy. JACC Cardiovasc Imaging. 2017;10(9):1031-8. [CrossRef] google scholar