ACC: Multi-detector CT has high predictive value for obstructive CAD detection

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ATLANTA -- The presence of obstructive coronary artery disease (CAD) was found to be a significant predictor of adverse cardiac events, and multi-detector CT may be able to predict cardiac events in known or suspected CAD, according to researchers from the Division of Cardiology at Daegu Catholic University in Daegu, South Korea. The researchers announced their findings during a poster presentation at the 59th annual American College of Cardiology (ACC) conference on Sunday.

So Yeon Kim, MD, and colleagues said that in the noninvasive evaluation of CAD-symptomatic patients, most clinicians have relied on stress nuclear myocardial perfusion imaging and echocardiography. However, clinicians have begun to employ multi-detector CT on this patient population. The researchers sought to determine the association of cardiac events with severity and extent of CAD by way of multi-detector CT.

“In patients presenting with suspected or known [CAD], assessment of prognosis is essential in selecting appropriate patient management,” said Kim.

The authors reviewed the cases of 897 patients (387 males and 510 females) with known or suspected CAD who had no prior history of revascularization. The researchers analyzed the severity and extent of CAD, as well as plaque of the coronary arteries.

Primary endpoints of the study included the occurrence of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization and revascularization.

Each patient underwent 64-slice multi-detector CT and Kim and colleagues determined that 590 patients (65.8 percent) had CAD.  After a follow-up period ranging from four months to 22 months, it was determined that 52 patients (5.8 percent) had experienced cardiac events. Higher event rates were observed in patients with obstructive CAD, wrote the researchers.

In addition, the authors noted that in males, hypertension, presence of plaque in the proximal left anterior descending (LAD) artery, the left main coronary artery and the proximal right coronary artery, as well as obstructive CAD, were determined to be significantly associated with cardiac events. “In multivariate analysis, a significant predictor of cardiac event was obstructive CAD,” said Kim.

In their evaluation of multi-detector CT for the study of patients with known CAD, the researchers concluded that the imaging modality has good prognostic values, and may be used on this patient population for the noninvasive detection of the disease state.