Why the study?
It was unclear which variables on coronary CTA and vasodilator stress-echocardiography are best associated with long-term cardiac outcome in suspected chronic coronary syndrome.
Which variables on coronary computed tomography angiography (CACS, number of stenosed vessels) and vasodilator stress echocardiography (RWMA, CFVR) are best associated with long-term cardiac death or myocardial infarction in patients with suspected chronic coronary syndrome?
Cohort (n=397)
No
Which variables on coronary computed tomography angiography (CACS, number of stenosed vessels) and vasodilator stress echocardiography (RWMA, CFVR) are best associated with long-term cardiac death or myocardial infarction in patients with suspected chronic coronary syndrome?
In patients with suspected chronic coronary syndrome undergoing both CTA and vasodilator stress echocardiography, coronary flow velocity reserve (CFVR) and coronary artery calcium score (CACS) independently predict 10-year cardiac death or myocardial infarction, outperforming traditional ischemia hallmarks like regional wall motion abnormalities and obstructive coronary stenosis.
May refine long-term risk stratification in suspected chronic coronary syndrome; leaves open whether integration alters management or outcomes.
Aims: This study aimed to assess which variables on coronary computed tomography angiography (CTA) and vasodilator stress-echocardiography (SE) are best associated with long-term cardiac outcome in patients presenting for suspected chronic coronary syndrome (CCS) who performed both tests. Methods: We identified 397 patients with suspected CCS who, between 2007 and 2019, underwent both SE and CTA within 30 days. Coronary artery calcium score (CACS) and the number of coronary arteries with diameter stenosis >50% were assessed on CTA. The presence of reversible regional wall motion abnormalities (RWMA) and reduced Doppler coronary flow velocity reserve in the left-anterior descending coronary artery (CFVR) were assessed on SE. The association of SE and CTA variables with cardiac outcome (cardiac death or myocardial infarction) was evaluated using Fine and Gray competing risk models. Results: During a median follow-up of 10 years, 38 (9.6%) patients experienced a nonfatal myocardial infarction and 19 (4.8%) died from a cardiac cause. RWMA (HR 7.189, p < 0.001) and a lower CFVR (HR 0.034, p < 0.001) on SE, along with CACS (HR 1.004, p < 0.001) and the number of >50% stenosed coronary vessels (HR 1.975, p < 0.001) on CTA, were each associated with cardiac events. After adjusting for covariates, only CACS and CFVR remained associated (both p < 0.001) with cardiac outcome. Conclusion: Our data suggest that only CFVR on vasodilatory SE and CACS on CTA are independently and strongly associated with long-term cardiac outcome, unlike RWMA or the number of stenosed coronary arteries, usually considered the hallmarks of coronary artery disease on each test.
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Gaibazzi et al. (2023) conducted a cohort in Suspected chronic coronary syndrome (CCS) (n=397). Reduced coronary flow velocity reserve (CFVR < 2) on stress echocardiography and coronary artery calcium score (CACS) on CTA vs. Normal CFVR (≥ 2), CACS categories, reversible regional wall motion abnormalities (RWMA), and number of coronary vessels with >50% stenosis was evaluated on Combined endpoint of cardiac death or nonfatal myocardial infarction (HR 0.044, 95% CI 0.014-0.142, p=<0.001).
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