In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
Abstract:
Introduction: Symptoms suggestive of coronary artery disease (CAD) are common, but no randomized comparison of the prognostic value of coronary computed tomographic angiography (CTA) vs. functional testing has been performed. Methods: Patients (10,003) with suspected CAD were randomized to functional testing (exercise ECG, nuclear stress, or stress echo) or CTA. Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. Cox proportional hazards models assessed the relationship of test results to a composite of time to death, myocardial infarction, or unstable angina, and the discriminatory ability of the two tests was compared using the C-index. Adjusted HRs for events in patients with abnormal vs. normal test results were determined for CTA and functional testing. Results: Overall, 4516 patients received CTA and 4572 functional testing as the randomized diagnostic test. The proportions of normal, mild, moderate, and severe abnormalities on CTA were 33.3%, 42.7%, 10.0%, and 14.0%, respectively, and for functional testing 78.9%, 8.5%, 4.2%, and 8.4% (P=0.001). Event rates over 26.0 months’ (IQR 18.0, 34.4) follow-up were similar: CTA 137/4516 (3.0%) vs. functional 132/4572 (2.9%). Compared to patients with normal CTAs, those with abnormal CTAs had increasing HRs for events with increasingly severe abnormalities, while only patients with moderate and severely abnormal functional testing had an increased HR for events (Figure). The probability of having an event given a normal test result was lower for CTA compared to functional testing (0.9% vs. 2.2%; HR 0.47 [95% CI 0.26, 0.83] ; P=0.009), but not significantly different for other test strata. The overall prognostic performance (C-index) of CTA vs. functional testing was 0.72 (0.68, 0.76) vs. 0.64 (0.60, 0.69); P=0.022 (see KM curves in Figure). Conclusions: In symptomatic patients with suspected CAD, CTA has better prognostic value than functional testing.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.132.suppl_3.18053
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2015
detail.hit.zdb_id:
1466401-X
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