Skip to main content
Journal cover image

Prognostic value of CT angiography in patients with inconclusive functional stress tests.

Publication ,  Journal Article
de Azevedo, CF; Hadlich, MS; Bezerra, SG; Petriz, JL; Alves, RR; de Souza, O; Rati, M; Albuquerque, DC; Moll, J
Published in: JACC. Cardiovascular imaging
July 2011

We attempted to determine the prognostic value of coronary computed tomographic angiography (CTA) in patients with inconclusive functional stress tests.Patients with suspected coronary artery disease (CAD) and inconclusive noninvasive cardiac stress tests represent a frequent management challenge.We examined 529 consecutive patients with suspected CAD and prior inconclusive functional stress tests. All patients underwent a coronary CTA scan using a 64-slice multidetector row scanner. CAD severity by coronary CTA was categorized as: 1) no evidence of CAD; 2) nonobstructive coronary plaques (< 30%); 3) mild stenosis (30% to 49%); 4) moderate stenosis (50% to 69%); and 5) severe stenosis (≥ 70%). Patients were also categorized according to a modified Duke prognostic CAD index. Survival analyses were performed using Cox proportional hazards models adjusted for baseline risk factors and coronary artery calcium score. The primary outcome of the study was the combined endpoint of all-cause mortality and nonfatal myocardial infarction.Among patients with inconclusive stress tests, the large majority (69%) did not demonstrate significant CAD by coronary CTA. During a mean follow-up of 30.1 ± 11.1 months, there were 20 (3.8%) deaths and 17 (3.2%) nonfatal myocardial infarctions. Multivariable Cox regression analysis revealed that the presence of increasing degrees of obstructive CAD by CTA was an independent predictor of adverse events (hazard ratio [HR]: 1.66 [95% confidence interval (CI): 1.23 to 2.23], p = 0.001). Indeed, the presence of ≥ 50% coronary stenosis was associated with an increased risk of events (HR: 3.15 [95% CI: 1.26 to 7.89], p = 0.01). Likewise, the Duke prognostic CAD index was also found to be an independent predictor of events (HR: 1.54 [95% CI: 1.20 to 1.97], p = 0.001).Among patients with inconclusive functional stress tests, the noninvasive assessment of CAD severity by coronary CTA has been shown to provide incremental prognostic information beyond the evaluation of traditional risk factors and coronary artery calcium score.

Published In

JACC. Cardiovascular imaging

DOI

EISSN

1876-7591

ISSN

1936-878X

Publication Date

July 2011

Volume

4

Issue

7

Start / End Page

740 / 751

Related Subject Headings

  • Tomography, X-Ray Computed
  • Time Factors
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Perfusion Imaging
  • Myocardial Infarction
 

Citation

APA
Chicago
ICMJE
MLA
NLM
de Azevedo, C. F., Hadlich, M. S., Bezerra, S. G., Petriz, J. L., Alves, R. R., de Souza, O., … Moll, J. (2011). Prognostic value of CT angiography in patients with inconclusive functional stress tests. JACC. Cardiovascular Imaging, 4(7), 740–751. https://doi.org/10.1016/j.jcmg.2011.02.017
Azevedo, Clerio F. de, Marcelo S. Hadlich, Sabrina G. Bezerra, João L. Petriz, Rogério R. Alves, Olga de Souza, Miguel Rati, Denilson C. Albuquerque, and Jorge Moll. “Prognostic value of CT angiography in patients with inconclusive functional stress tests.JACC. Cardiovascular Imaging 4, no. 7 (July 2011): 740–51. https://doi.org/10.1016/j.jcmg.2011.02.017.
de Azevedo CF, Hadlich MS, Bezerra SG, Petriz JL, Alves RR, de Souza O, et al. Prognostic value of CT angiography in patients with inconclusive functional stress tests. JACC Cardiovascular imaging. 2011 Jul;4(7):740–51.
de Azevedo, Clerio F., et al. “Prognostic value of CT angiography in patients with inconclusive functional stress tests.JACC. Cardiovascular Imaging, vol. 4, no. 7, July 2011, pp. 740–51. Epmc, doi:10.1016/j.jcmg.2011.02.017.
de Azevedo CF, Hadlich MS, Bezerra SG, Petriz JL, Alves RR, de Souza O, Rati M, Albuquerque DC, Moll J. Prognostic value of CT angiography in patients with inconclusive functional stress tests. JACC Cardiovascular imaging. 2011 Jul;4(7):740–751.
Journal cover image

Published In

JACC. Cardiovascular imaging

DOI

EISSN

1876-7591

ISSN

1936-878X

Publication Date

July 2011

Volume

4

Issue

7

Start / End Page

740 / 751

Related Subject Headings

  • Tomography, X-Ray Computed
  • Time Factors
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Perfusion Imaging
  • Myocardial Infarction