Publication Date

8-1-2018

Journal

The Texas Heart Journal

DOI

10.14503/THIJ-17-6270

PMID

30374228

Publication Date(s)

August 2018

Language

English

PMCID

PMC6183632

PubMedCentral® Posted Date

8-1-2018

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Cardiac-gated imaging techniques, coronary angiography/methods/standards, coronary artery disease/diagnostic imaging, coronary vessels/pathology, image processing, computer-assisted, models, cardiovascular, predictive value of tests, radiation dosage, retrospective studies, tomography, x-ray computed/methods

Abstract

Coronary computed tomographic angiography (CCTA) with prospective electrocardiographic gating reduces radiation exposure, but its prognostic power for predicting cardiovascular risk in patients with suspected CAD has not been fully validated. To determine whether prospective gating performs as well as retrospective gating in this population, we compared these scan modes in patients undergoing 64-slice CCTA.

From January 2009 through September 2011, 1,407 patients underwent CCTA; of these, 915 (mean age, 57.8 ± 13.5 yr; 54% male) had suspected coronary artery disease at the time of CCTA and were included in the study. Prospective gating was used in 195 (21%) and retrospective gating in 720 (79%). The mean follow-up duration was 2.4 ± 0.9 years.

Overall, 390 patients (42.6%) had normal results on CCTA, 382 (41.7%) had nonobstructive coronary artery disease, and 143 (15.6%) had obstructive disease. Major adverse cardiac events occurred in 32 patients (3.5%): 11 cardiac deaths, 15 late revascularizations, and 6 nonfatal myocardial infarctions. Total event occurrences were similar in both groups (retrospective, 3.8%; prospective, 2.6%; P=0.42), as were the occurrences of each type of event. On adjusted multivariate analysis, nonobstructive (P=0.015) and obstructive (P <0.001) coronary artery disease were independently associated with major adverse cardiac events. Scan mode was not a predictor of outcome. The mean effective radiation dose was 4 ± 2 mSv for prospective compared with 12 ± 4 mSv for retrospective gating (P <0.01).

The prognostic value of CCTA with prospective electrocardiographic gating compares favorably with that of retrospective gating, and it involves significantly less radiation exposure.

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