Prognostic value of computed tomographic coronary angiography and exercise electrocardiography for cardiovascular events
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Key result
CTCA stenosis ≥50% predicts ~643% higher cardiovascular risk, with exercise ECG adding no predictive value.
- HR 7.426
- 95% CI 2.685-20.525
- P<0.001
- n=442
Why the study?
Does computed tomography coronary angiography predict cardiovascular events better than exercise electrocardiography in patients with chest pain?
Population
442 patients with chest pain who underwent both exercise electrocardiography and computed tomography…
Comparison
Computed tomography coronary angiography… vs Exercise electrocardiography evaluating…
Design
Cohort
Follow-up
mean 2.8 ± 1.1 years
Authors
Discussion
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Implication
CTCA stenosis was associated with events in this cohort; leaves open whether it outperforms exercise ECG without randomized validation.
Study Design
Type
Cohort (n=442)
Multicenter
No
Structured PICO
Does computed tomography coronary angiography predict cardiovascular events better than exercise electrocardiography in patients with chest pain?
P
Population
442 adult patients with chest pain and predominantly low-to-intermediate pretest probability of coronary artery disease, followed for a mean of 2.8 years.
E
Exposure
Computed tomography coronary angiography (CTCA) evaluating coronary artery calcium score, presence of plaque, and coronary artery stenosis
C
Comparator
Exercise electrocardiography (ex-ECG) evaluating negative/positive results and Duke treadmill score
O
Outcome
Composite of cardiovascular events (unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death) at mean 2.8 years follow-upcomposite
Main Result
Hazard Ratio: 7.426 (95% CI 2.685–20.525)
p-value: p=<0.001
CTCA is superior to exercise ECG for predicting long-term cardiovascular outcomes in low- to intermediate-risk patients with chest pain, and their combination does not add predictive value over CTCA alone.
Limitations
- Retrospective study design leading to potential selection bias
- Small number of cardiac events and low overall event rate
- Small sample size of high-risk patients
- Inability to collect information on patient medications
- Novel parameters of ex-ECG and CTCA (such as plaque characteristics) were not assessed
Cite This Study
Kim et al. (2016) conducted a cohort in Chest pain (suspected coronary artery disease) (n=442). Coronary artery stenosis ≥ 50% on CTCA vs. Absence of coronary artery stenosis ≥ 50% was evaluated on Cardiovascular events (unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death) (HR 7.426, 95% CI 2.685-20.525, p=<0.001). Coronary artery stenosis ≥ 50% detected by CTCA independently predicted long-term cardiovascular events (HR 7.426), and adding exercise ECG did not significantly improve predictive value.
Topics
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