TY - JOUR
T1 - Prognostic value of coronary CTAvs. exercise treadmilltesting
T2 - Results fromthePartnersregistry
AU - Cheezum, Michael K.
AU - Subramaniyam, Premsrinivas
AU - Bittencourt, Marcio S.
AU - Hulten, Edward A.
AU - Ghoshhajra, Brian B.
AU - Shah, Nishant R.
AU - Forman, Daniel E.
AU - Hainer, Jon
AU - Leavitt, Marcia
AU - Padmanabhan, Ram
AU - Skali, Hicham
AU - Dorbala, Sharmila
AU - Hoffmann, Udo
AU - Abbara, Suhny
AU - Di Carli, Marcelo F.
AU - Gewirtz, Henry
AU - Blankstein, Ron
N1 - Funding Information:
We acknowledge the patients and outstanding dedication of the exercise physiologists and imaging technologists at Brigham and Women''s Hospital and Massachusetts General Hospital. Conflict of interest: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The opinions and assertions contained herein are the authors'' alone, and do not constitute endorsement by the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, or the United States Government.
Publisher Copyright:
© 2015 The Author.
PY - 2015/12
Y1 - 2015/12
N2 - Aims We sought to compare the complementary prognostic value of exercise treadmill testing (ETT) and coronary computed tomographic angiography (CTA) among patients referred for both exams. Methods and results We studied 582 patients without known coronary artery disease (CAD) who were clinically referred for ETT and CTA within 6 months. Patientswere followed for cardiovascular (CV) death, non-fatal myocardial infarction (MI), or late revascularization (>90 days), stratified by Duke Treadmill Score (DTS) and CAD severity (≥50% stenosis). Mean age was 54±13 years (63% male). In median follow-up of 40 months, therewere 3 CV deaths, 7 non-fatal MIs, and 26 late revascularizations. ETTwas inconclusive in 23%, positive in 31%, and negative in 46%.CTAdemonstrated noCADin 37%, nonobstructive CADin 28%, and obstructive CADin 35%. Among low-risk ETT patients (n = 326), therewere 3 MI, 10 late revascularizations, and the frequent presence of non-obstructive (32%, n = 105) and obstructive CAD (27%, n = 88). When present, ETT features (i.e. angina, DTS, ischaemic electrocardiogram changes, and exercise capacity) individually failed to predict CV death/MI after adjustment for Morise score. Conversely, both obstructive CAD [HR 4.9 (1.0.23.3), P = 0.048] and CAD extent by segment involvement score >4 [HR 3.9 (1.0.15.2), P = 0.049] predicted increased risk for CV death or MI. Conclusion Patients with a low-risk ETT have an excellent prognosis at 40 months, despite the frequent presence of non-obstructive (32%) and obstructive (27%) CAD. In patients with an intermediate-to high-risk ETT (DTS <5), CTA can provide incremental risk stratification for future CV events.
AB - Aims We sought to compare the complementary prognostic value of exercise treadmill testing (ETT) and coronary computed tomographic angiography (CTA) among patients referred for both exams. Methods and results We studied 582 patients without known coronary artery disease (CAD) who were clinically referred for ETT and CTA within 6 months. Patientswere followed for cardiovascular (CV) death, non-fatal myocardial infarction (MI), or late revascularization (>90 days), stratified by Duke Treadmill Score (DTS) and CAD severity (≥50% stenosis). Mean age was 54±13 years (63% male). In median follow-up of 40 months, therewere 3 CV deaths, 7 non-fatal MIs, and 26 late revascularizations. ETTwas inconclusive in 23%, positive in 31%, and negative in 46%.CTAdemonstrated noCADin 37%, nonobstructive CADin 28%, and obstructive CADin 35%. Among low-risk ETT patients (n = 326), therewere 3 MI, 10 late revascularizations, and the frequent presence of non-obstructive (32%, n = 105) and obstructive CAD (27%, n = 88). When present, ETT features (i.e. angina, DTS, ischaemic electrocardiogram changes, and exercise capacity) individually failed to predict CV death/MI after adjustment for Morise score. Conversely, both obstructive CAD [HR 4.9 (1.0.23.3), P = 0.048] and CAD extent by segment involvement score >4 [HR 3.9 (1.0.15.2), P = 0.049] predicted increased risk for CV death or MI. Conclusion Patients with a low-risk ETT have an excellent prognosis at 40 months, despite the frequent presence of non-obstructive (32%) and obstructive (27%) CAD. In patients with an intermediate-to high-risk ETT (DTS <5), CTA can provide incremental risk stratification for future CV events.
KW - Coronary artery disease
KW - Coronary computed tomographic angiography
KW - Exercise testing
KW - Major adverse cardiac events
KW - Prognosis
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U2 - 10.1093/ehjci/jev087
DO - 10.1093/ehjci/jev087
M3 - Article
C2 - 25899714
AN - SCOPUS:84943557803
SN - 2047-2404
VL - 16
SP - 1338
EP - 1346
JO - European heart journal cardiovascular Imaging
JF - European heart journal cardiovascular Imaging
IS - 12
ER -