TY - JOUR
T1 - 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
T2 - Combined CTA/CTP for Long-Term Patient Outcome
AU - Dewey, Marc
AU - Rochitte, Carlos E.
AU - Ostovaneh, Mohammad R.
AU - Chen, Marcus Y.
AU - George, Richard
AU - Niinuma, Hiroyuki
AU - Kitagawa, Kakuya
AU - Laham, Roger
AU - Kofoed, Klaus
AU - Nomura, Cesar
AU - Sakuma, Hajime
AU - Yoshioka, Kunihiro
AU - Mehra, Vishal C.
AU - Jinzaki, Masahiro
AU - Kuribayashi, Sachio
AU - Laule, Michael
AU - Paul, Narinder
AU - Scholte, Arthur J.
AU - Cerci, Rodrigo
AU - Hoe, John
AU - Tan, Swee Yaw
AU - Rybicki, Frank J.
AU - Matheson, Matthew B.
AU - Vavere, Andrea L.
AU - Arai, Andrew E.
AU - Miller, Julie M.
AU - Cox, Christopher
AU - Brinker, Jeffrey
AU - Clouse, Melvin E.
AU - Di Carli, Marcelo
AU - Lima, João A.C.
AU - Arbab-Zadeh, Armin
N1 - Funding Information:
This work was funded in part by intramural research support from the NHLBI , National Institutes of Health, USA . The CORE320 cross-sectional study with limited follow up was funded by Canon (formerly Toshiba) Medical Systems.
Publisher Copyright:
© 2021 Society of Cardiovascular Computed Tomography
PY - 2021/11/1
Y1 - 2021/11/1
N2 - 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.
AB - 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.
KW - CT angiography
KW - Coronary artery disease
KW - Coronary atherosclerosis
KW - Coronary heart disease
KW - Coronary imaging
KW - Myocardial perfusion imaging
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U2 - 10.1016/j.jcct.2021.04.005
DO - 10.1016/j.jcct.2021.04.005
M3 - Article
C2 - 34024757
AN - SCOPUS:85106361879
VL - 15
SP - 485
EP - 491
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
SN - 1934-5925
IS - 6
ER -