Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-Year outcomes of the ROMICAT trial

Christopher L. Schlett, Dahlia Banerji, Emily Siegel, Fabian Bamberg, Sam J. Lehman, Maros Ferencik, Thomas J. Brady, John T. Nagurney, Udo Hoffmann, Quynh A. Truong

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Abstract

Objectives: The aim of this study was to determine the 2-year prognostic value of cardiac computed tomography (CT) for predicting major adverse cardiac events (MACE) in patients presenting to the emergency department (ED) with acute chest pain. Background: CT has high potential for early triage of acute chest pain patients. However, there is a paucity of data regarding the prognostic value of CT in this ED cohort. Methods: We followed 368 patients from the ROMICAT (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial (age 53 ± 12 years; 61% male) who presented to the ED with acute chest pain, negative initial troponin, and a nonischemic electrocardiogram for 2 years. Contrast-enhanced 64-slice CT was obtained during index hospitalization, and caregivers and patients remained blinded to the results. CT was assessed for the presence of plaque, stenosis (>50% luminal narrowing), and left ventricular regional wall motion abnormalities (RWMA). The primary endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: Follow-up was completed in 333 patients (90.5%) with a median follow-up period of 23 months. At the end of the follow-up period, 25 patients (6.8%) experienced 35 MACE (no cardiac deaths, 12 myocardial infarctions, and 23 revascularizations). Cumulative probability of 2-year MACE increased across CT strata for coronary artery disease (CAD) (no CAD 0%; nonobstructive CAD 4.6%; obstructive CAD 30.3%; log-rank p <0.0001) and across combined CT strata for CAD and RWMA (no stenosis or RWMA 0.9%; 1 feature - either RWMA [15.0%] or stenosis [10.1%], both stenosis and RWMA 62.4%; log-rank p <0.0001). The c statistic for predicting MACE was 0.61 for clinical Thrombolysis In Myocardial Infarction risk score and improved to 0.84 by adding CT CAD data and improved further to 0.91 by adding RWMA (both p <0.0001). Conclusions: CT coronary and functional features predict MACE and have incremental prognostic value beyond clinical risk score in ED patients with acute chest pain. The absence of CAD on CT provides a 2-year MACE-free warranty period, whereas coronary stenosis with RWMA is associated with the highest risk of MACE.

Original languageEnglish (US)
Pages (from-to)481-491
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume4
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

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Acute Pain
Chest Pain
Hospital Emergency Service
Myocardial Infarction
Tomography
Coronary Artery Disease
Pathologic Constriction
Computed Tomography Angiography
Troponin
Triage
Coronary Stenosis
Caregivers
Electrocardiography
Hospitalization

Keywords

  • computed tomography angiography
  • coronary artery disease
  • emergency department
  • long-term outcome
  • major adverse cardiac events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department : 2-Year outcomes of the ROMICAT trial. / Schlett, Christopher L.; Banerji, Dahlia; Siegel, Emily; Bamberg, Fabian; Lehman, Sam J.; Ferencik, Maros; Brady, Thomas J.; Nagurney, John T.; Hoffmann, Udo; Truong, Quynh A.

In: JACC: Cardiovascular Imaging, Vol. 4, No. 5, 05.2011, p. 481-491.

Research output: Contribution to journalArticle

Schlett, Christopher L. ; Banerji, Dahlia ; Siegel, Emily ; Bamberg, Fabian ; Lehman, Sam J. ; Ferencik, Maros ; Brady, Thomas J. ; Nagurney, John T. ; Hoffmann, Udo ; Truong, Quynh A. / Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department : 2-Year outcomes of the ROMICAT trial. In: JACC: Cardiovascular Imaging. 2011 ; Vol. 4, No. 5. pp. 481-491.
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title = "Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-Year outcomes of the ROMICAT trial",
abstract = "Objectives: The aim of this study was to determine the 2-year prognostic value of cardiac computed tomography (CT) for predicting major adverse cardiac events (MACE) in patients presenting to the emergency department (ED) with acute chest pain. Background: CT has high potential for early triage of acute chest pain patients. However, there is a paucity of data regarding the prognostic value of CT in this ED cohort. Methods: We followed 368 patients from the ROMICAT (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial (age 53 ± 12 years; 61{\%} male) who presented to the ED with acute chest pain, negative initial troponin, and a nonischemic electrocardiogram for 2 years. Contrast-enhanced 64-slice CT was obtained during index hospitalization, and caregivers and patients remained blinded to the results. CT was assessed for the presence of plaque, stenosis (>50{\%} luminal narrowing), and left ventricular regional wall motion abnormalities (RWMA). The primary endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: Follow-up was completed in 333 patients (90.5{\%}) with a median follow-up period of 23 months. At the end of the follow-up period, 25 patients (6.8{\%}) experienced 35 MACE (no cardiac deaths, 12 myocardial infarctions, and 23 revascularizations). Cumulative probability of 2-year MACE increased across CT strata for coronary artery disease (CAD) (no CAD 0{\%}; nonobstructive CAD 4.6{\%}; obstructive CAD 30.3{\%}; log-rank p <0.0001) and across combined CT strata for CAD and RWMA (no stenosis or RWMA 0.9{\%}; 1 feature - either RWMA [15.0{\%}] or stenosis [10.1{\%}], both stenosis and RWMA 62.4{\%}; log-rank p <0.0001). The c statistic for predicting MACE was 0.61 for clinical Thrombolysis In Myocardial Infarction risk score and improved to 0.84 by adding CT CAD data and improved further to 0.91 by adding RWMA (both p <0.0001). Conclusions: CT coronary and functional features predict MACE and have incremental prognostic value beyond clinical risk score in ED patients with acute chest pain. The absence of CAD on CT provides a 2-year MACE-free warranty period, whereas coronary stenosis with RWMA is associated with the highest risk of MACE.",
keywords = "computed tomography angiography, coronary artery disease, emergency department, long-term outcome, major adverse cardiac events",
author = "Schlett, {Christopher L.} and Dahlia Banerji and Emily Siegel and Fabian Bamberg and Lehman, {Sam J.} and Maros Ferencik and Brady, {Thomas J.} and Nagurney, {John T.} and Udo Hoffmann and Truong, {Quynh A.}",
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T1 - Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department

T2 - 2-Year outcomes of the ROMICAT trial

AU - Schlett, Christopher L.

AU - Banerji, Dahlia

AU - Siegel, Emily

AU - Bamberg, Fabian

AU - Lehman, Sam J.

AU - Ferencik, Maros

AU - Brady, Thomas J.

AU - Nagurney, John T.

AU - Hoffmann, Udo

AU - Truong, Quynh A.

PY - 2011/5

Y1 - 2011/5

N2 - Objectives: The aim of this study was to determine the 2-year prognostic value of cardiac computed tomography (CT) for predicting major adverse cardiac events (MACE) in patients presenting to the emergency department (ED) with acute chest pain. Background: CT has high potential for early triage of acute chest pain patients. However, there is a paucity of data regarding the prognostic value of CT in this ED cohort. Methods: We followed 368 patients from the ROMICAT (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial (age 53 ± 12 years; 61% male) who presented to the ED with acute chest pain, negative initial troponin, and a nonischemic electrocardiogram for 2 years. Contrast-enhanced 64-slice CT was obtained during index hospitalization, and caregivers and patients remained blinded to the results. CT was assessed for the presence of plaque, stenosis (>50% luminal narrowing), and left ventricular regional wall motion abnormalities (RWMA). The primary endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: Follow-up was completed in 333 patients (90.5%) with a median follow-up period of 23 months. At the end of the follow-up period, 25 patients (6.8%) experienced 35 MACE (no cardiac deaths, 12 myocardial infarctions, and 23 revascularizations). Cumulative probability of 2-year MACE increased across CT strata for coronary artery disease (CAD) (no CAD 0%; nonobstructive CAD 4.6%; obstructive CAD 30.3%; log-rank p <0.0001) and across combined CT strata for CAD and RWMA (no stenosis or RWMA 0.9%; 1 feature - either RWMA [15.0%] or stenosis [10.1%], both stenosis and RWMA 62.4%; log-rank p <0.0001). The c statistic for predicting MACE was 0.61 for clinical Thrombolysis In Myocardial Infarction risk score and improved to 0.84 by adding CT CAD data and improved further to 0.91 by adding RWMA (both p <0.0001). Conclusions: CT coronary and functional features predict MACE and have incremental prognostic value beyond clinical risk score in ED patients with acute chest pain. The absence of CAD on CT provides a 2-year MACE-free warranty period, whereas coronary stenosis with RWMA is associated with the highest risk of MACE.

AB - Objectives: The aim of this study was to determine the 2-year prognostic value of cardiac computed tomography (CT) for predicting major adverse cardiac events (MACE) in patients presenting to the emergency department (ED) with acute chest pain. Background: CT has high potential for early triage of acute chest pain patients. However, there is a paucity of data regarding the prognostic value of CT in this ED cohort. Methods: We followed 368 patients from the ROMICAT (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial (age 53 ± 12 years; 61% male) who presented to the ED with acute chest pain, negative initial troponin, and a nonischemic electrocardiogram for 2 years. Contrast-enhanced 64-slice CT was obtained during index hospitalization, and caregivers and patients remained blinded to the results. CT was assessed for the presence of plaque, stenosis (>50% luminal narrowing), and left ventricular regional wall motion abnormalities (RWMA). The primary endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: Follow-up was completed in 333 patients (90.5%) with a median follow-up period of 23 months. At the end of the follow-up period, 25 patients (6.8%) experienced 35 MACE (no cardiac deaths, 12 myocardial infarctions, and 23 revascularizations). Cumulative probability of 2-year MACE increased across CT strata for coronary artery disease (CAD) (no CAD 0%; nonobstructive CAD 4.6%; obstructive CAD 30.3%; log-rank p <0.0001) and across combined CT strata for CAD and RWMA (no stenosis or RWMA 0.9%; 1 feature - either RWMA [15.0%] or stenosis [10.1%], both stenosis and RWMA 62.4%; log-rank p <0.0001). The c statistic for predicting MACE was 0.61 for clinical Thrombolysis In Myocardial Infarction risk score and improved to 0.84 by adding CT CAD data and improved further to 0.91 by adding RWMA (both p <0.0001). Conclusions: CT coronary and functional features predict MACE and have incremental prognostic value beyond clinical risk score in ED patients with acute chest pain. The absence of CAD on CT provides a 2-year MACE-free warranty period, whereas coronary stenosis with RWMA is associated with the highest risk of MACE.

KW - computed tomography angiography

KW - coronary artery disease

KW - emergency department

KW - long-term outcome

KW - major adverse cardiac events

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