Morphologic and Functional Assessment of Coronary Artery Disease

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  • Kasai Tokuo
    Division of Cardiology, Jikei University Katsushika Medical Center

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  • Combined Computed Tomography Angiography (CTA) and Single Photon Emission Computed Tomography Is Not Superior to CTA Plus High-Risk Plaque Assessment in Predicting Future Cardiac Events
  • . Morphologic and functional assessment of coronary artery disease - potential application of computed tomography angiography and myocardial perfusion imaging.
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Background: The role of combined evaluation of myocardial perfusion imaging (MPI; by single-photon emission computed tomography) and computed tomography angiography (CTA) for risk stratification of coronary artery disease was evaluated. For CTA, the extent of luminal stenosis, and also the features of high-risk plaques (HRP, including positive remodeling and low attenuation) were evaluated. Methods and Results: A total of 304 patients (65±11 years, male 72%, median follow-up: 24 months) who underwent CTA and MPI were enrolled in the study. Summed stress scores and summed difference scores (SDS) for MPI, stenosis, and HRP were evaluated, and event rates were compared. Cardiac events were defined as acute coronary event including cardiac death or non-fatal acute myocardial infarction, and unstable angina requiring revascularization. Of 304 patients, 51 (16.8%) underwent early revascularization. In the remaining 253 patients, an event occurred in 11 (4.3%). HRP (hazard ratio [HR], 4.75, P=0.00171) and stenosis (+) with SDS >0 (HR, 4.58, P=0.0461) were significant independent predictors of cardiac event. The event rate for stenosis (+) with SDS >0 was significantly higher than others (log-rank P=0.0490). The event rates were significantly different between HRP(+) and HRP(–) (16.1% vs. 2.7%, log-rank P=0.0013). Conclusions: HRP on CTA was an independent predictor of acute coronary events, as was stenosis (+) with SDS >0, and HRP had increased prognostic value over stenosis and abnormal MPI findings.  (Circ J 2013; 77: 411–417)<br>

収録刊行物

  • Circulation Journal

    Circulation Journal 77 (2), 317-318, 2013

    一般社団法人 日本循環器学会

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