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Differential Prognostic Value of Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiography in Asymptomatic Subjects

 Sang-Eun Lee  ;  Iksung Cho  ;  Geu-Ru Hong  ;  Hyuk-Jae Chang  ;  Ji Min Sung  ;  In-Jeong Cho  ;  Chi Young Shim  ;  Byoung Wook Choi  ;  Namsik Chung 
 Journal of Cardiovascular Ultrasound, Vol.23(4) : 244-252, 2015 
Journal Title
 Journal of Cardiovascular Ultrasound 
Issue Date
Asymptomatic population ; Coronary artery disease ; Coronary computed tomography angiography ; Exercise electrocardiography
BACKGROUND: To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects. METHODS: We retrospectively enrolled 812 (59 ± 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA. RESULTS: The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 ± 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991). CONCLUSION: CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.
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1. Journal Papers (연구논문) > 5. Research Institutes (연구소) > Yonsei Cardiovascular Research Institute (심혈관연구소)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
성지민(Sung, Ji Min)
심지영(Shim, Chi Young)
이상은(Lee, Sang Eun) ORCID logo https://orcid.org/0000-0001-6645-4038
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정남식(Chung, Nam Sik)
조익성(Cho, Ik Sung)
조인정(Cho, In Jeong)
최병욱(Choi, Byoung Wook) ORCID logo https://orcid.org/0000-0002-8873-5444
홍그루(Hong, Geu Ru)
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