Prognostic value of coronary CTAvs. exercise treadmilltesting: Results fromthePartnersregistry

Michael K. Cheezum, Premsrinivas Subramaniyam, Marcio S. Bittencourt, Edward A. Hulten, Brian B. Ghoshhajra, Nishant R. Shah, Daniel E. Forman, Jon Hainer, Marcia Leavitt, Ram Padmanabhan, Hicham Skali, Sharmila Dorbala, Udo Hoffmann, Suhny Abbara, Marcelo F. Di Carli, Henry Gewirtz, Ron Blankstein

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Abstract

Aims We sought to compare the complementary prognostic value of exercise treadmill testing (ETT) and coronary computed tomographic angiography (CTA) among patients referred for both exams. Methods and results We studied 582 patients without known coronary artery disease (CAD) who were clinically referred for ETT and CTA within 6 months. Patientswere followed for cardiovascular (CV) death, non-fatal myocardial infarction (MI), or late revascularization (>90 days), stratified by Duke Treadmill Score (DTS) and CAD severity (≥50% stenosis). Mean age was 54±13 years (63% male). In median follow-up of 40 months, therewere 3 CV deaths, 7 non-fatal MIs, and 26 late revascularizations. ETTwas inconclusive in 23%, positive in 31%, and negative in 46%.CTAdemonstrated noCADin 37%, nonobstructive CADin 28%, and obstructive CADin 35%. Among low-risk ETT patients (n = 326), therewere 3 MI, 10 late revascularizations, and the frequent presence of non-obstructive (32%, n = 105) and obstructive CAD (27%, n = 88). When present, ETT features (i.e. angina, DTS, ischaemic electrocardiogram changes, and exercise capacity) individually failed to predict CV death/MI after adjustment for Morise score. Conversely, both obstructive CAD [HR 4.9 (1.0.23.3), P = 0.048] and CAD extent by segment involvement score >4 [HR 3.9 (1.0.15.2), P = 0.049] predicted increased risk for CV death or MI. Conclusion Patients with a low-risk ETT have an excellent prognosis at 40 months, despite the frequent presence of non-obstructive (32%) and obstructive (27%) CAD. In patients with an intermediate-to high-risk ETT (DTS

Original languageEnglish (US)
Pages (from-to)1338-1346
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Volume16
Issue number12
DOIs
StatePublished - 2015

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Keywords

  • Coronary artery disease
  • Coronary computed tomographic angiography
  • Exercise testing
  • Major adverse cardiac events
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Cheezum, M. K., Subramaniyam, P., Bittencourt, M. S., Hulten, E. A., Ghoshhajra, B. B., Shah, N. R., Forman, D. E., Hainer, J., Leavitt, M., Padmanabhan, R., Skali, H., Dorbala, S., Hoffmann, U., Abbara, S., Di Carli, M. F., Gewirtz, H., & Blankstein, R. (2015). Prognostic value of coronary CTAvs. exercise treadmilltesting: Results fromthePartnersregistry. European Heart Journal Cardiovascular Imaging, 16(12), 1338-1346. https://doi.org/10.1093/ehjci/jev087