Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study
Key result
CCTA-determined three-vessel or left main disease is linked to ~341% greater risk of major events.
- HR 4.41
- 95% CI 2.90-6.69
- n=16,949
Why the study?
The 3.5-year prognosis of stable coronary artery disease evaluated by coronary computed tomography angiography in real-world clinical practice, overall and across demographic and comorbidity subgroups, needed examination.
Does the severity of coronary artery disease determined by CCTA predict the risk of late revascularization, myocardial infarction, and all-cause death in patients with new-onset symptoms suggestive of CAD?
Population
16,949 patients with new-onset symptoms suggestive of CAD undergoing CCTA
Comparison
Patients with CAD (by severity) vs patients without CAD
Design
Multicentre cohort study
Follow-up
3.5 years
Authors
Discussion
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Implication
CCTA stratifies 3.5-year risk in symptomatic stable CAD; extends prior cohorts but leaves open effects on management and outcomes.
Key Points
- To assess the long-term prognosis of stable coronary artery disease using coronary computed tomography angiography in a clinical setting.
- Cohort study involving 16,949 patients with new-onset symptoms suggestive of CAD.
- Assessment of outcomes over 3.5 years, focusing on composite endpoints of revascularization, myocardial infarction, and all-cause death.
- Utilization of the Kaplan-Meier estimator and Cox-regression for risk comparisons.
- Composite endpoint occurred in 486 patients; risk was 1.5% for those without CAD, 6.8% for obstructive CAD, and 15% for three-vessel/left main disease.
- Higher relative risk of composite endpoint observed for non-obstructive CAD (HR: 1.28; 95% CI: 1.01-1.63), obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95% CI: 2.90-6.69).
- Results consistent across different age, sex, and comorbidity strata.
Study Design
Type
Cohort (n=16,949)
Multicenter
Yes
Structured PICO
Does the severity of coronary artery disease determined by CCTA predict the risk of late revascularization, myocardial infarction, and all-cause death in patients with new-onset symptoms suggestive of CAD?
P
Population
16,949 patients with new-onset symptoms suggestive of stable coronary artery disease (CAD), median age 57 years, 57% women.
I
Intervention
Presence of coronary artery disease (non-obstructive, obstructive one-vessel, two-vessel, or three-vessel/left main) determined by coronary computed tomography angiography (CCTA)
C
Comparator
Absence of coronary artery disease determined by CCTA
O
Outcome
Composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death at 3.5 yearscomposite
Main Result
Effect estimate: HR 4.41 (95% CI 2.90-6.69)
Absolute Event Rate: 15% vs 1.5%
CCTA-determined CAD severity strongly predicts the 3.5-year risk of late revascularization, myocardial infarction, and death in patients with stable symptoms.
Cite This Study
Nielsen et al. (2016) conducted a cohort in stable coronary artery disease (n=16,949). Coronary computed tomography angiography (CCTA) vs. Patients without CAD was evaluated on composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death (HR 4.41, 95% CI 2.90-6.69). CCTA-determined CAD severity predicted the 3.5-year risk of late revascularization, MI, and death, with hazard ratios up to 4.41 (95% CI 2.90-6.69) for three-vessel/left main disease.