Prognostic Value of Multislice Computed Tomography and Gated Single-Photon Emission Computed Tomography in Patients With Suspected Coronary Artery Disease

Objectives This study was designed to determine whether multislice computed tomography (MSCT) coronary angiography has incremental prognostic value over single-photon emission computed tomography myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD). Background Although MSCT is used for the detection of CAD in addition to MPI, its incremental prognostic value is unclear. Methods In 541 patients (59% male, age 59 +/- 11 years) referred for further cardiac evaluation, both MSCT and MPI were performed. The following events were recorded: all-cause death, nonfatal infarction, and unstable angina requiring revascularization. Results In the 517 (96%) patients with an interpretable MSCT, significant CAD (MSCT >= 50% stenosis) was detected in 158 (31%) patients, and abnormal perfusion (summed stress score [ SSS]: >= 4) was observed in 168 (33%) patients. During follow-up (median 672 days; 25th, 75th percentile: 420, 896), an event occurred in 23 (5.2%) patients. After correction for baseline characteristics in a multivariate model, MSCT emerged as an independent predictor of events with an incremental prognostic value to MPI. The annualized hard event rate (all-cause mortality and nonfatal infarction) in patients with none or mild CAD (MSCT >= 50% stenosis) was 1.8% versus 4.8% in patients with significant CAD (MSCT >= 50% stenosis). A normal MPI (SSS = 4) were associated with an annualized hard event rate of 1.1% and 3.8%, respectively. Both MSCT and MPI were synergistic, and combined use resulted in significantly improved prediction (log-rank test p value