Long-term prognosis following exclusion of coronary artery stenosis by noninvasive coronary angiography using multislice computed tomography (MSCT) up to now has not been determined. We therefore performed noninvasive coronary angiography using MSCT (Philips Brilliance, 4 – 64 slices, retrospective ECG gating, 0.625mm collimation, 0.4sec gantry rotation time) in 1017 consecutive patients (657 male, 360 female, age 64±11years, 240 patients with known coronary artery disease (CAD)) referred to MSCT-study with chest pain. Patients with acute coronary syndromes, stents, atrial fibrillation and calcium scores > 1500 were not included. Based on MSCT results invasive study was recommended or not. All patients or the referring clinician were contacted by telephone or mail at least 6 months after their scan. Diagnostic image quality could be obtained in 992/1017 (98%) patients. In 620 of 992 patients (=63%) coronary artery stenosis could be excluded and invasive study was not recommended. Despite these recommendations invasive study was performed due to other clinical indications in 83/620 patients within < 30 days and in 43/537 patients within > 30days after the scan. Only in 13/126 patients stenoses >50% were found but no treatment was necessary. During the mean follow-up period of 612±192days 7/620 patients died but no patient suffered from cardiac death or acute myocardial infarction. In 372 of 992 patients invasive coronary angiography was recommended and performed in 230 patients (n=167 within < 30days, n=63 within >30days). In 165/230 patients stenoses >50% were found, treated by angioplasty or stents in 139/165 patients. During the mean follow-up period of 602±161days 11/372 patients died, two patients suffered from sudden, two patients from non-sudden cardiac death and one patient survived acute myocardial infarction. Thus, exclusion of coronary artery stenoses by noninvasive coronary angiography using multislice computed tomography determines a good lomg-term prognosis in patients with chest pain.
Multislice computed tomography for noninvasive coronary angiography: Diagnostic accuracy of volume rendering versus maximum intensity projection reconstructions