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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

Comparison of the receiver operating characteristic curves with the computed tomographic coronary angiography and exercise electrocardiography results. DTS, Duke treadmill score; CACS, coronary artery calcium score.
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f3-kjim-2015-263: Comparison of the receiver operating characteristic curves with the computed tomographic coronary angiography and exercise electrocardiography results. DTS, Duke treadmill score; CACS, coronary artery calcium score.

Mentions: For the comparison of predictive values between the CTCA and ex-ECG parameters, a ROC curve analysis of each parameter was performed (Table 4). The area under the curve (AUC) of the single or combined parameters of CTCA and ex-ECG were obtained and compared with DTS ≤ 4 as a reference value. Stenosis ≥ 50%, presence of plaque and CACS > 40 among CTCA findings were significant predictive values of clinical outcome in the comparison of ROC curve analysis. In the ROC curve analysis, stenosis ≥ 50% had the largest AUC in single parameters (AUC area, 0.699; 95% confidence interval [CI], 0.654 to 0.741; p = 0.003). However DTS ≤ 4 did not show statistical significance in the ROC curve analysis. When adding stenosis ≥ 50% to DTS ≤ 4, the combination predictor showed the maximal AUC area and significant difference compared to DTS ≤ 4 (p = 0.024). However, a combination of three parameters (including stenosis ≥ 50%, CACS > 40, and DTS ≤ 4) did not show significant difference in comparison of ROC curve analysis (Table 4, Fig. 3).


Prognostic value of computed tomographic coronary angiography and exercise electrocardiography for cardiovascular events
Comparison of the receiver operating characteristic curves with the computed tomographic coronary angiography and exercise electrocardiography results. DTS, Duke treadmill score; CACS, coronary artery calcium score.
© Copyright Policy
Related In: Results  -  Collection

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

f3-kjim-2015-263: Comparison of the receiver operating characteristic curves with the computed tomographic coronary angiography and exercise electrocardiography results. DTS, Duke treadmill score; CACS, coronary artery calcium score.
Mentions: For the comparison of predictive values between the CTCA and ex-ECG parameters, a ROC curve analysis of each parameter was performed (Table 4). The area under the curve (AUC) of the single or combined parameters of CTCA and ex-ECG were obtained and compared with DTS ≤ 4 as a reference value. Stenosis ≥ 50%, presence of plaque and CACS > 40 among CTCA findings were significant predictive values of clinical outcome in the comparison of ROC curve analysis. In the ROC curve analysis, stenosis ≥ 50% had the largest AUC in single parameters (AUC area, 0.699; 95% confidence interval [CI], 0.654 to 0.741; p = 0.003). However DTS ≤ 4 did not show statistical significance in the ROC curve analysis. When adding stenosis ≥ 50% to DTS ≤ 4, the combination predictor showed the maximal AUC area and significant difference compared to DTS ≤ 4 (p = 0.024). However, a combination of three parameters (including stenosis ≥ 50%, CACS > 40, and DTS ≤ 4) did not show significant difference in comparison of ROC curve analysis (Table 4, Fig. 3).

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