Skip to main content
SpringerLink
Log in

The Prognostic Significance of Coronary CT Angiography

  • Cardiac PET, CT, and MRI (S Achenbach, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Coronary computed tomography angiography (CTA) is an increasingly utilized, highly accurate noninvasive test for the diagnosis of coronary artery disease. Accumulating data have convincingly demonstrated that the presence, extent, and location of both obstructive and nonobstructive coronary atherosclerosis visualized on coronary CTA conveys powerful prognostic information, incremental to that provided by clinical variables and coronary calcium scoring. Proposed markers of future plaque instability and coronary risk, such as the degree of vessel remodeling and low-attenuation plaque volume, as well as measures of CT myocardial perfusion, may further improve the prognostic value of CTA. Ultimately, studies are needed to assess whether the prognostic information provided by coronary CTA testing results in sustained changes in patient and provider behaviors that cost effectively improve patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CONFIRM:

Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter (Registry)

CT-STAT:

Coronary Computed Tomography for Systematic Triage of Acute Chest Pain Patients to Treatment

ROMICAT:

Rule Out Myocardial Infarction Using Computer Assisted Tomography

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98.

    Article  PubMed  CAS  Google Scholar 

  2. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation. 2011;123:e18–e209.

    Article  PubMed  Google Scholar 

  3. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362:886–95.

    Article  PubMed  CAS  Google Scholar 

  4. Heijenbrok-Kal MH, Fleischmann KE. Hunink MG Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance. Am Heart J. 2007;154:415–23.

    Article  PubMed  Google Scholar 

  5. Metz LD, Beattie M, Hom R, et al. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007;49:227–37.

    Article  PubMed  Google Scholar 

  6. • Schuetz GM, Zacharopoulou NM, Schlattmann P, et al. Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. Ann Intern Med. 2010;152:167–77. This is an important recent meta-analysis reporting the accuracy of coronary CTA.

    PubMed  Google Scholar 

  7. •• Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation appropriate use criteria task force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr. 2010;4:407–33. This is the current consensus statement regarding the appropriate indications for performing cardiac CT.

    PubMed  Google Scholar 

  8. Min JK, Shaw LJ, Devereux RB, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50:1161–70.

    Article  PubMed  Google Scholar 

  9. Mark DB, Nelson CL, Califf RM, et al. Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty. Circulation. 1994;89:2015–25.

    PubMed  CAS  Google Scholar 

  10. • Chow BJ, Wells GA, Chen L, et al. Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol. 2010;55:1017–28. This is the first large, prospective study to assess the prognostic value of 64-slice coronary CTA.

    Article  PubMed  Google Scholar 

  11. •• Hulten EA, Carbonaro S, Petrillo SP, et al. Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;57:1237–47. This is the first large meta-analysis to review the data on prognosis following coronary CTA.

    Article  PubMed  Google Scholar 

  12. Wilson PW, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47.

    PubMed  CAS  Google Scholar 

  13. Bamberg F, Sommer WH, Hoffmann V, et al. Meta-analysis and systematic review of the long-term predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography. J Am Coll Cardiol. 2011;57:2426–36.

    Article  PubMed  Google Scholar 

  14. • Lin FY, Shaw LJ, Dunning AM, et al. Mortality risk in symptomatic patients with nonobstructive coronary artery disease: a prospective 2-center study of 2,583 patients undergoing 64-detector row coronary computed tomographic angiography. J Am Coll Cardiol. 2011;58:510–19. This study emphasizes and confirms the prognostic importance of nonobstructive CAD on coronary CTA in a symptomatic cohort.

    Article  PubMed  Google Scholar 

  15. •• Min JK, Dunning A, Lin FY, et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the international multicenter CONFIRM (Coronary CT angiography evaluation for clinical outcomes: an international multicenter registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol. 2011;58:849–60. The CONFIRM registry is the largest database prospectively assessing the prognostic implications of cardiac CT.

    Article  PubMed  Google Scholar 

  16. •• Chow BJ, Small G, Yam Y, et al. The incremental prognostic value of cardiac CT in CAD using CONFIRM (COroNary computed tomography angiography evaluation for clinical outcomes: an InteRnational Multicenter registry). Circ Cardiovasc Imaging. 2011. This is a publication from the CONFIRM registry demonstrating the incremental prognostic value of coronary CTA.

  17. Kwon SW, Kim YJ, Shim J, et al. Coronary artery calcium scoring does not add prognostic value to standard 64-section CT angiography protocol in low-risk patients suspected of having coronary artery disease. Radiology. 2011;259:92–9.

    Article  PubMed  Google Scholar 

  18. Russo V, Zavalloni A, Bacchi Reggiani ML, et al. Incremental prognostic value of coronary CT angiography in patients with suspected coronary artery disease. Circ Cardiovasc Imaging. 2010;3:351–9.

    Article  PubMed  Google Scholar 

  19. •• Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary computed tomographic angiography for systematic triage of acute chest pain patients to treatment) trial. J Am Coll Cardiol. 2011;58:1414–22. This is a multicenter trial demonstrating that the early use of coronary CTA in patients presenting with acute chest pain is more time and cost-efficient and safe, compared with stress myocardial perfusion imaging.

    Article  PubMed  Google Scholar 

  20. Schlett CL, Banerji D, Siegel E, et al. Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-year outcomes of the ROMICAT trial. JACC Cardiovasc Imaging. 2011;4:481–91.

    Article  PubMed  Google Scholar 

  21. Romagnoli A, Patrei A, Mancini A, et al. Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries. Radiol Med. 2010;115:1167–78.

    Article  PubMed  CAS  Google Scholar 

  22. Nieman K, Pattynama PM, Rensing BJ, et al. Evaluation of patients after coronary artery bypass surgery: CT angiographic assessment of grafts and coronary arteries. Radiology. 2003;229:749–56.

    Article  PubMed  Google Scholar 

  23. Chow BJ, Ahmed O, Small G, et al. Prognostic value of CT angiography in coronary bypass patients. JACC Cardiovasc Imaging. 2011;4:496–502.

    Article  PubMed  Google Scholar 

  24. • Voros S, Rinehart S, Qian Z, et al. Coronary atherosclerosis imaging by coronary CT angiography: current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging. 2011;4:537–48. This is an excellent review and meta-analysis comparing coronary CTA measures of plaque to invasive coronary imaging techniques, such as IVUS.

    Article  PubMed  Google Scholar 

  25. Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364(3):226–35.

    Article  PubMed  CAS  Google Scholar 

  26. Virmani R, Burke AP, Farb A, et al. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47:C13–8.

    Article  PubMed  CAS  Google Scholar 

  27. Schroeder S, Kopp AF, Baumbach A, et al. Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol. 2001;37:1430–5.

    Article  PubMed  CAS  Google Scholar 

  28. Carrascosa PM, Capunay CM, Garcia-Merletti P, et al. Characterization of coronary atherosclerotic plaques by multidetector computed tomography. Am J Cardiol. 2006;97:598–602.

    Article  PubMed  Google Scholar 

  29. Motoyama S, Kondo T, Anno H, et al. Atherosclerotic plaque characterization by 0.5-mm-slice multislice computed tomographic imaging. Circ J. 2007;71:363–6.

    Article  PubMed  Google Scholar 

  30. Petranovic M, Soni A, Bezzera H, et al. Assessment of nonstenotic coronary lesions by 64-slice multidetector computed tomography in comparison to intravascular ultrasound: evaluation of nonculprit coronary lesions. J Cardiovasc Comput Tomogr. 2009;3:24–31.

    Article  PubMed  Google Scholar 

  31. Motoyama S, Kondo T, Sarai M, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319–26.

    Article  PubMed  Google Scholar 

  32. Pflederer T, Marwan M, Schepis T, et al. Characterization of culprit lesions in acute coronary syndromes using coronary dual-source CT angiography. Atherosclerosis. 2010;211:437–44.

    Article  PubMed  CAS  Google Scholar 

  33. • Motoyama S, Sarai M, Harigaya H, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54:49–57. This is the first prospective study assessing the prognostic value of plaque characteristics that predict future ACS.

    Article  PubMed  Google Scholar 

  34. Murabito JM, Evans JC, Larson MG, et al. Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation. Circulation. 1993;88:2548–55.

    PubMed  CAS  Google Scholar 

  35. Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303:1610–6.

    Article  PubMed  CAS  Google Scholar 

  36. Arad Y, Goodman KJ, Roth M, et al. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol. 2005;46:158–65.

    Article  PubMed  CAS  Google Scholar 

  37. Blaha MJ, Budoff MJ, DeFilippis AP, et al. Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study. Lancet. 2011;378:684–92.

    Article  PubMed  CAS  Google Scholar 

  38. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010;56:e50–103.

    Article  PubMed  Google Scholar 

  39. Perrone-Filardi P, Achenbach S, Mohlenkamp S, et al. Cardiac computed tomography and myocardial perfusion scintigraphy for risk stratification in asymptomatic individuals without known cardiovascular disease: a position statement of the Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology. Eur Heart J. 2011;32:1986–93.

    Article  PubMed  Google Scholar 

  40. Achenbach S, Goroll T, Seltmann M, et al. Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. JACC Cardiovasc Imaging. 2011;4:328–37.

    Article  PubMed  Google Scholar 

  41. Choi EK, Choi SI, Rivera JJ, et al. Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol. 2008;52:357–65.

    Article  PubMed  Google Scholar 

  42. McEvoy JW, Blaha MJ, Nasir K, et al. Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population. Arch Intern Med. 2011;171:1260–8.

    Article  PubMed  Google Scholar 

  43. Hadamitzky M, Meyer T, Hein F, et al. Prognostic value of coronary computed tomographic angiography in asymptomatic patients. Am J Cardiol. 2010;105:1746–51.

    Article  PubMed  Google Scholar 

  44. Min JK, Berman DS, Budoff MJ, et al. Rationale and design of the DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic AngiOgraphy) study. J Cardiovasc Comput Tomogr. 2011;5:301–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The views expressed here are those of the authors only, and are not to be construed as those of the Department of the Army or Department of Defense.

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Kevin M. Woods, Collin Fischer, Michael K. Cheezum & Todd C. Villines

  2. Division of Cardiology, Brigham and Women’s Hospital, Boston, MA, USA

    Edward A. Hulten

  3. Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Binh Nguyen

  4. Uniformed Services University, Bethesda, MD, USA

    Todd C. Villines

  5. Department of Cardiovascular Research, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA

    Todd C. Villines

Authors
  1. Kevin M. Woods
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Collin Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael K. Cheezum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward A. Hulten
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Binh Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Todd C. Villines
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Todd C. Villines.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Woods, K.M., Fischer, C., Cheezum, M.K. et al. The Prognostic Significance of Coronary CT Angiography. Curr Cardiol Rep 14, 7–16 (2012). https://doi.org/10.1007/s11886-011-0226-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-011-0226-x

Keywords

Search

Navigation