Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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DIFFERENTIAL PROGNOSTIC VALUE OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY IN RELATION TO EXERCISE ELECTROCARDIOGRAPHY IN ASYMPTOMATIC SUBJECTS

  • Lee, Sang-Eun (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Cho, Iksung (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Hong, Geu-Ru (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Chang, Hyuk-Jae (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Sung, Ji Min (Department of Research Affairs, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Cho, In-Jeong (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Shim, Chi Young (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Choi, Byoung Wook (Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Chung, Namsik (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System)
  • Received : 2015.10.12
  • Accepted : 2015.12.07
  • Published : 2015.12.27
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Abstract

BACKGROUND: To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects. METHODS: We retrospectively enrolled 812 ($59{\pm}9years$, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA. RESULTS: The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of $37{\pm}16months$, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991). CONCLUSION: CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

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