| 권성우¹, 장혁재¹, 심재민¹, 강동원¹, 한미은¹, 최병욱² , 김영진², 장양수¹, 정남식¹ |
Cardiac computed tomography(CT) is being increasingly performed to assess for obstructive CAD in symptomatic population. Coronary artery calcium scoring(CACS) have been proven as an independent prognostic indicator and, with the advent of multi-slice CT technology, coronary CT angiography(CCTA) has provided comprehensive information of atherosclerotic plaque with better spatial resolution than electron-beam CT. To date, however, there is a paucity of data regarding the optimal protocol for current standard of multi-slice CT(MSCT) to predict outcomes in patients with suspected coronary artery disease(CAD). We retrospectively enrolled 4,338 patients(54% male, 60±10years) who had undergone cardiac CT(64-row MSCT) for the evaluation of suspected CAD in Severance Hospital between 2003 and 2009. CCTA results were categorized as the presence of obstructive(≥50%), and non-obstructive(<50%) CAD or normal. Patients underwent elective revascularization within 60 days after index CT study were excluded from the analysis. During a mean follow up of 707±437 days, the major adverse cardiac event(MACE) was 222(5%)(7,all-cause mortality; 3,non-fatal myocardial infarct; 212,revascularization). The presence of obstructive CAD on CCTA is an independent predictor of MACE in a multivariate analysis adjusted for clinical risk factors and CACS, which increased stepwise with increasing the number of stenosed vessels(1VD,OR:4.6,95% CI:1.4-15.6,p=0.015; 2VD,OR:10.9,95% CI:2.0-59.2,p=0.006; 3VD,OR:188.1,95% CI:27.8-1273.6,p<0.0001). In ROC analysis, comparison of AUC(area under curve) between CCTA and CACS+CCTA for all age subgroup revealed no significant difference in predictive value of MACE, both of which were better than CACS only.(Figure) In current MSCT era, CCTA is better than CACS in predicting MACE in patients with suspected CAD. Furthermore, combined CACS is no more beneficial than current standard of CCTA in patients with suspected CAD. Considering radiation exposure, CACS did no longer need to be incorporated to Cardiac CT protocol in this population.
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