ADDITIVE PROGNOSTIC VALUE OF CT ANGIOGRAPHY AS COMPARED TO EXERCISE ECG IN PATIENTS WITH LOW AND INTERMEDIATE RISK OF CAD

PURPOSE: Our aim was to compare the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). METHODS: We enrolled 60 patients (age 61.3 ± 10.4 years, 40 men) with angina and no history of CAD. All underwent ex-ECG and CTA and were followed for 12 months. The endpoints were cardiac events - nonfatal myocardial infarction, cardiac death, and revascularization. RESULTS: ex-ECG and CTA were positive in 36 (60%) and 24 (40%) of 60 patients, respectively. Both ex-ECG and CTA were predictors of cardiac events (hazard ratio [HR]: 2, p < 0.0001 and HR: 20, 95% p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% ,p = 0.02 and HR: 6.8; p < 0.0001, respectively), in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Ex-ECG provides a further risk stratification in the subset of patients with positive findings on CTA and a low to intermediate likelihood of CAD. Positive findings on CTA identify a shorter event-free period. CONCLUSION: CTA has a higher prognostic value compared with ex-ECG in patients with low to intermediate pretest likelihood of CAD.