Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris

AbstractThe prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16  %) and during a median follow-up of 19 months (range 12–22 months) 25 patients (10 %) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations). Accuracy for the prediction of MACE expressed as the area under curve (AUC) on receiver-operating characteristic curve s was 0.88 (0.83–0.92) for visual assessment of a PD and 0.80 (0.73–0.85) for stress TPR (transmural perfusion ratio). After adjustment for the pretest probability of obstructive coronary artery disease, both detection of a PD and stress TPR were significantly associated with MACE with an adjust ed hazard ratio of 39 (95 % confidence interval 11–134), p <  0.0001, for visual interpretation and 0.99 (0.98–0.99) for stress TPR, p <  0.0001. Patients with a PD volume covering>10  % of the LV myocardium had a worse prognosis compared to patients with a PD covering<10  % of the LV myocardium, p = 0.0002. The optimal cut-off value of ...

Source: The International Journal of Cardiovascular Imaging - October 6, 2016 Category: Radiology Source Type: research