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Prognostic value of computed tomographic coronary angiography and exercise electrocardiography for cardiovascular events

View Article: PubMed Central - PubMed

ABSTRACT

Background/aims:: This study is a head-to-head comparison of predictive values for long-term cardiovascular outcomes between exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) in patients with chest pain.

Methods:: Four hundred and forty-two patients (mean age, 56.1 years; men, 61.3%) who underwent both ex-ECG and CTCA for evaluation of chest pain were included. For ex-ECG parameters, the patients were classified according to negative or positive results, and Duke treadmill score (DTS). Coronary artery calcium score (CACS), presence of plaque, and coronary artery stenosis were evaluated as CTCA parameters. Cardiovascular events for prognostic evaluation were defined as unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death.

Results:: The mean follow-up duration was 2.8 ± 1.1 years. Fifteen patients experienced cardiovascular events. Based on pretest probability, the low- and intermediate-risks of coronary artery disease were 94.6%. Odds ratio of CACS > 40, presence of plaque, coronary stenosis ≥ 50% and DTS ≤ 4 were significant (3.79, p = 0.012; 9.54, p = 0.030; 6.99, p < 0.001; and 4.58, p = 0.008, respectively). In the Cox regression model, coronary stenosis ≥ 50% (hazard ratio, 7.426; 95% confidence interval, 2.685 to 20.525) was only significant. After adding DTS ≤ 4 to coronary stenosis ≥ 50%, the integrated discrimination improvement and net reclassification improvement analyses did not show significant.

Conclusions:: CTCA was better than ex-ECG in terms of predicting long-term outcomes in low- to intermediate-risk populations. The predictive value of the combination of CTCA and ex-ECG was not superior to that of CTCA alone.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier plots for event-free survival for (A) coronary tomographic coronary angiography (CTCA) stenosis ≥ 50%, (B) presence of plaques, (C) coronary artery calcium score (CACS) > 40, and (D) Duke treadmill score (DTS) ≤ 4.
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f2-kjim-2015-263: Kaplan-Meier plots for event-free survival for (A) coronary tomographic coronary angiography (CTCA) stenosis ≥ 50%, (B) presence of plaques, (C) coronary artery calcium score (CACS) > 40, and (D) Duke treadmill score (DTS) ≤ 4.

Mentions: Among the CTCA parameters, CACS > 40, presence of plaque, and coronary artery stenosis ≥ 50% statistically differed between the no-event and event groups (Table 2). The three CTCA parameters had significant predictive values (Table 3). Presence of plaque showed high sensitivity, and negative predictive value as 93.3% and 99.4%. However, it had low specificity and positive predictive value. In addition, multivessel disease did not predict the occurrence of cardiovascular disease (data was not shown). A Kaplan-Meier survival curve showed that the rate of event-free survival was lower in the patients with than in those without coronary stenosis ≥ 50% on CTCA (Fig. 2). The cardiovascular event-free survival of the patients showed significant difference in terms of whether plaque and CACS > 40 were present (Fig. 2).


Prognostic value of computed tomographic coronary angiography and exercise electrocardiography for cardiovascular events
Kaplan-Meier plots for event-free survival for (A) coronary tomographic coronary angiography (CTCA) stenosis ≥ 50%, (B) presence of plaques, (C) coronary artery calcium score (CACS) > 40, and (D) Duke treadmill score (DTS) ≤ 4.
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5016286&req=5

f2-kjim-2015-263: Kaplan-Meier plots for event-free survival for (A) coronary tomographic coronary angiography (CTCA) stenosis ≥ 50%, (B) presence of plaques, (C) coronary artery calcium score (CACS) > 40, and (D) Duke treadmill score (DTS) ≤ 4.
Mentions: Among the CTCA parameters, CACS > 40, presence of plaque, and coronary artery stenosis ≥ 50% statistically differed between the no-event and event groups (Table 2). The three CTCA parameters had significant predictive values (Table 3). Presence of plaque showed high sensitivity, and negative predictive value as 93.3% and 99.4%. However, it had low specificity and positive predictive value. In addition, multivessel disease did not predict the occurrence of cardiovascular disease (data was not shown). A Kaplan-Meier survival curve showed that the rate of event-free survival was lower in the patients with than in those without coronary stenosis ≥ 50% on CTCA (Fig. 2). The cardiovascular event-free survival of the patients showed significant difference in terms of whether plaque and CACS > 40 were present (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background/aims:: This study is a head-to-head comparison of predictive values for long-term cardiovascular outcomes between exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) in patients with chest pain.

Methods:: Four hundred and forty-two patients (mean age, 56.1 years; men, 61.3%) who underwent both ex-ECG and CTCA for evaluation of chest pain were included. For ex-ECG parameters, the patients were classified according to negative or positive results, and Duke treadmill score (DTS). Coronary artery calcium score (CACS), presence of plaque, and coronary artery stenosis were evaluated as CTCA parameters. Cardiovascular events for prognostic evaluation were defined as unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death.

Results:: The mean follow-up duration was 2.8 ± 1.1 years. Fifteen patients experienced cardiovascular events. Based on pretest probability, the low- and intermediate-risks of coronary artery disease were 94.6%. Odds ratio of CACS > 40, presence of plaque, coronary stenosis ≥ 50% and DTS ≤ 4 were significant (3.79, p = 0.012; 9.54, p = 0.030; 6.99, p < 0.001; and 4.58, p = 0.008, respectively). In the Cox regression model, coronary stenosis ≥ 50% (hazard ratio, 7.426; 95% confidence interval, 2.685 to 20.525) was only significant. After adding DTS ≤ 4 to coronary stenosis ≥ 50%, the integrated discrimination improvement and net reclassification improvement analyses did not show significant.

Conclusions:: CTCA was better than ex-ECG in terms of predicting long-term outcomes in low- to intermediate-risk populations. The predictive value of the combination of CTCA and ex-ECG was not superior to that of CTCA alone.

No MeSH data available.


Related in: MedlinePlus