The Effect Of CCTA Risk Stratification On The Prognosis Of Coronary Heart Disease

Background：Atherosclerotic cardiovascular disease is a worldwide pandemic disease andcauses more and more deaths annually. Optimal medical therapy (OMT),percutaneous coronary intervention (PCI) and coronary artery bypass grafting(CABG), are the most common treatment of coronary heart disease, but still remainscontroversial. We prospectively followed a group of patients for four-five years whounderwent coronary computed tomography angiography (CCTA) for major adversecardiac events (MACE). We hypothesized that the results of this trial would reliablyreflect the natural outcome of the coronary disease.Methods:1. Consecutive patients who underwent CCTA from June2008to May2009wereselected. Those who could not be reached by telephone, had significant angina,had CT images that were not interpretable, or poor kidney and left ventricular(LV) function were excluded. There was no significant difference between OMTand PCI in terms of risk. The patients were divided into five groups: group Anormal CCTA without stenosis, group B mild stenosis (1% 49%), group Cmoderate stenosis (50% 74%), group D severe stenosis (≥75%) and they weretreated with optimal medical therapy (OMT) or PCI. The group E had PCIbefore the CCTA examination. The patients were then followed for MACE afterdifferent treatments. MACE included acute myocardial infarction (MI), heartfailure (HF) and all-cause of death.2. Consecutive patients who underwent CCTA from2008to2009were selected.Those who must underwent coronary computed tomography angiography orcoronary angiography for the first time (De novo CCTA or De novo CAG). Theywere treated with PCI or CABG. All the lesions were evaluated by the Syntaxscore. The patients were then followed for MACE after different treatments.MACE included acute myocardial infarction (MI), heart failure (HF) andall-cause of death. Results:1. The patient population consisted of419patients. The follow-up time was (51±5)months. The age was (60±31) years. Male made up67.78%of the population(n=284). A total of51cases of MACE occurred including25MI,8HF and18all-cause deaths. There was no MACE in group A. Although MACE occurred intwo patients in group B, they were not attributed to cardiac death. We furthercompared the MACE in groups C–E and no significant difference was found(P>0.05). However, a difference was detected among patients with unstableangina pectoris (UAP), stable angina pectoris (SAP), re-hospitalization, andcerebrovascular events from groups A–E (P <0.05). The plaque scores were usedto predict MACE. The scores progressively increased significantly with lesionseverity (P <0.05). Receiver operating curve (ROC) was performed to determinethe sensitivity and specificity in predicting MACE. Our scores predicted MI witharea of0.76, predicted HF with area of0.83, and predicted death with area of0.77.2. The patient population consisted of502patients. The follow-up time was (67±6)months. The age was (59±17) years. Male made up76.10%of the population(n=382). A total of50cases of MACE occurred including15MI,7HF,19all-cause deaths and9CV. There was no significant difference in the MACE intwo groups (P>0.05), but there was significant difference in the CV (P <0.05).Receiver operating curve (ROC) was performed to determine the sensitivity andspecificity in predicting MACE.Conclusions:Normal and mild lesions had very few events. With increased stenosis theMACE rate increased progressively. PCI did not significantly reduce the MACE incomparison with OMT in asymptomatic patients. Furthermore, UAP,re-hospitalization, and re-PCI were significantly increased in patients who weretreated with PCI. Also, PCI did not significantly reduce the MACE in comparisonwith CABG. Because of the stent thrombosis, patients may cause the myocardialinfarction, even the death.