European Heart Journal Advance Access originally published online on January 19, 2009
European Heart Journal 2009 30(3):362-371; doi:10.1093/eurheartj/ehn605
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Prognostic utility of 64-slice computed tomography in patients with suspected but no documented coronary artery disease
1 Department of Cardiovascular Medicine, Desk F 15, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
2 Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
3 Department of Radiology, University of Florida, Jacksonville, FL, USA
Received 31 July 2008; revised 11 December 2008; accepted 22 December 2008; online publish-ahead-of-print 19 January 2009.
* Corresponding author. Tel: +1 216 445 5250, Fax: +1 216 636 0679, Email: desaim2{at}ccf.org
Aims: Although multislice computed tomography (MSCT) detects obstructive coronary artery disease (CAD) with high diagnostic accuracy, there is a paucity of long-term prognostic data. We sought to assess the incremental prognostic value of 64-slice CT in patients with suspected but no documented CAD.
Methods and results: Coronary MSCT was performed on 227 individuals (61% men, mean age 54 ± 12 years, 63% with intermediate pre-test probability) without documented CAD, referred for coronary evaluation. Coronary artery disease by MSCT was categorized as follows: none or mild CAD (<50%, n = 172), 
50% in one vessel (n = 23), two vessels [or in the proximal left anterior descending (LAD), n = 12], and three vessels (or in two vessels including the proximal LAD or left main, n = 20). Baseline risk factors, length of follow-up, and major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and coronary revascularization were recorded. Over a mean follow-up of 2.3 ± 0.8 years, there were 18 MACE [including four hard events (one cardiac death and three MIs)]. Also, patients with one or more vessel obstructive CAD had increased hard events compared with those with less than one-vessel disease (log-rank statistic P-value 0.01). One or more vessel obstructive CAD was a significant predictor of MACE on univariable and multivariable Cox proportional survival analysis [hazard ratios 29.1 (6.7–126.6) and 9.82 (3.58–27.01), respectively, both P < 0.0001]. In 172 patients, with no or mild CAD, there was 99% freedom from MACE during follow-up.
Conclusion: Multislice computed tomography-classified extent of CAD provides incremental prognostic information in patients with suspected but no documented CAD.
Key Words: Multislice computed tomography • Coronary arteries and prognosis
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