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Prognostic value of multidetector coronary computed tomography angiography in relation to exercise electrocardiogram in patients with suspected coronary artery disease

 Iksung Cho  ;  Jaemin Shim  ;  Hyuk-Jae Chang  ;  Ji Min Sung  ;  Youngtaek Hong  ;  Hackjoon Shim  ;  Young Jin Kim  ;  Byoung Wook Choi  ;  James K. Min  ;  Ji-Ye Kim  ;  Chi-Young Shim  ;  Geu-Ru Hong  ;  Namsik Chung 
 Journal of the American College of Cardiology, Vol.60(21) : 2205-15, 2012 
Journal Title
 Journal of the American College of Cardiology 
Issue Date
Adult ; Coronary Angiography/methods* ; Coronary Artery Disease/diagnosis* ; Coronary Artery Disease/physiopathology ; Diagnosis, Differential ; Electrocardiography* ; Exercise/physiology* ; Exercise Test/methods* ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography/methods* ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Time Factors
coronary computed tomographic angiography ; exercise electrocardiography ; prognosis
OBJECTIVES: This study was designed to determine the prognostic value of multidetector coronary computed tomography angiography (CTA) in relation to exercise electrocardiography (XECG) findings. BACKGROUND: The prognostic usefulness of coronary CTA findings of coronary artery disease in relation to XECG findings has not been explored systematically. METHODS: Patients with suspected coronary artery disease who had undergone both coronary CTA and XECG (<90 days between tests) from 2003 through 2009 were enrolled retrospectively. Coronary CTA results were classified according to the severity of maximal stenosis (normal, mild: <40% of luminal stenosis, moderate: 40% to 69%, severe: ≥70%), XECG results were categorized as positive and negative, and Duke XECG score was calculated. Clinical follow-up data were collected for major adverse cardiac events (MACE): cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization after 90 days from index coronary CTA. C-statistics were calculated to compare discriminatory values of each test. RESULTS: Among the 2,977 (58 ± 10 years) study patients, 12% demonstrated positive XECG results. By coronary CTA, patients were categorized as normal (56%) or having mild (26%), moderate (13%), or severe (5%) disease. During a median follow-up of 3.3 years (interquartile range: 2.3 to 4.6), 97 MACE were observed and the 5-year cumulative event rate was 3.6% (95% confidence interval: 3.0 to 4.3). Although both XECG (C-statistic: 0.790) and coronary CTA (C-statistic: 0.908) improved risk stratification beyond clinical risk factors (C-statistic: 0.746, p < 0.05 for all), XECG in addition to coronary CTA (C-statistic: 0.907) did not provide better discrimination than coronary CTA alone (p = 0.389). In subgroup analyses, coronary CTA stratified risk of MACE in groups with both positive and negative XECG results (all p < 0.001 for trend). However, positive XECG results predicted risk of MACE on coronary CTA only in the moderate stenosis group (hazard ratio: 2.58, 95% confidence interval: 1.29 to 5.19, p = 0.008) and severe stenosis group (hazard ratio: 2.28, 95% confidence interval: 1.19 to 4.38, p = 0.013). CONCLUSIONS: In patients with suspected coronary artery disease, coronary CTA discriminates future risk of MACE in patients independent of XECG results. Compared with coronary CTA, XECG has an additive prognostic value only in patients with moderate to severe stenosis on coronary CTA.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
5. Research Institutes (연구소) > Yonsei Cardiovascular Research Institute (심혈관연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Medical Research Center (임상의학연구센터) > 1. Journal Papers
Yonsei Authors
Sung, Ji Min(성지민)
Shim, Jae Min(심재민)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Shim, Hack Joon(심학준)
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Chung, Nam Sik(정남식)
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
Hong, Young Taek(홍영택)
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