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European Heart Journal Advance Access originally published online on June 29, 2009
European Heart Journal 2009 30(21):2622-2629; doi:10.1093/eurheartj/ehp272
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease

Jacob M. van Werkhoven1,2, Joanne D. Schuijf1, Oliver Gaemperli3,4, J. Wouter Jukema1,2, Lucia J. Kroft5, Eric Boersma6, Aju Pazhenkottil3,4, Ines Valenta4, Gabija Pundziute1, Albert de Roos5, Ernst E. van der Wall1,2, Philipp A. Kaufmann4,7 and Jeroen J. Bax1,*

1 Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
2 The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
3 Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
4 Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
5 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
6 Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
7 Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland

Received 26 November 2008; revised 25 May 2009; accepted 11 June 2009; online publish-ahead-of-print 29 June 2009.

* Corresponding author. Tel: +31 71 5262020, Fax: +31 71 5266809, Email: j.j.bax{at}lumc.nl

Aims: The purpose of this study was to assess the relationship between calcium scoring (CS) and multi-slice computed tomography coronary angiography (MSCTA) and to determine if MSCTA has an incremental prognostic value to CS.

Methods and results: In 432 patients (59% male, age 58 ± 11 years) referred for cardiac evaluation owing to suspected coronary artery disease (CAD), CS and 64-slice MSCTA were performed. The following events were combined in a composite endpoint: all-cause mortality, non-fatal infarction, and unstable angina requiring revascularization. CS was 0 in 147 (34%) patients, CS 1–99 was present in 122 (28%), CS 100–399 in 75 (17%), CS 400–999 in 56 (13%), and CS ≥ 1000 in 32 (7%). MSCTA was normal in 133 (31%) patients, MSCTA 30–50% stenosis was observed in 190 (44%), and MSCTA ≥50% stenosis in 109 (25%). During follow-up [median 670 days (25th–75th percentile: 418–895)], an event occurred in 21 patients (4.9%). After multivariate correction for CS, MSCTA ≥ 50% stenosis, the number of diseased segments, obstructive segments, and non-calcified plaques were independent predictors with an incremental prognostic value to CS.

Conclusion: MSCTA provides additional information to CS regarding stenosis severity and plaque composition. This additional information was shown to translate into incremental prognostic value over CS.

Key Words: Imaging • Atherosclerosis • Prognosis


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