Five-Year Outcomes After Coronary Computed Tomography Angiography (From 110,599 Patients in a Danish Nationwide Register-Based Follow-Up Study)

Kristian Kragholm*, Jeppe Grøndahl Rasmussen, Marc Meller Søndergaard, Tomas Zaremba, Bhupendar Tayal, Filip Lyng Lindgren, Holger Marquard Sejersen, Martin Bødtker Mortensen, Bjarne Linde Nørgaard, Jesper Møller Jensen, Hans Erik Bøtker, Christina Byrne, Lars Køber, Christian Torp-Pedersen, Niels Holmark Andersen, Peter Søgaard, Mamas Mamas, Phillip Freeman

*Corresponding author for this work

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Abstract

The long-term cardiovascular risk for patients examined with coronary computed tomography angiography (CCTA) to rule out coronary heart disease compared with population controls remains unexplored. A nationwide register-based study including first-time CCTA-examined patients between 2007 and 2017 in Denmark alive 180 days post-CCTA was conducted. We evaluated 5-year outcomes of myocardial infarction (MI) or revascularization and all-cause mortality in 3 distinct CCTA-groups: (1) no post-CCTA preventive pharmacotherapy use (cholesterol-lowering drugs, antiplatelets, or anticoagulants); (2) post-CCTA preventive pharmacotherapy use; and (3) revascularization or MI within 180 days post-CCTA. For each patient group, population controls were matched on age, gender, and calendar year. Absolute risks standardized to the age, gender, selected co-morbidity, and anti-anginal pharmacotherapy distributions of the specific CCTA-examined patients and respective controls were obtained from multivariable Cox regression. Of 110,599 CCTA-examined patients, (1) 48,231 patients were not prescribed preventive pharmacotherapy 180 days post-CCTA; (2) 42,798 patients were prescribed preventive pharmacotherapy within 180 days post-CCTA; and (3) 19,570 patients were diagnosed with MI or revascularized within 180 days post-CCTA. For patient groups 1 to 3 versus respective controls, 5-year MI or revascularization risks were <0.1% versus 2.0%, <0.1% versus 3.8%, and 19.0% versus 2.5%, all p<0.001. Five-year all-cause mortality were 2.8% versus 4.2%, 5.5% versus 8.8%, and 6.7% versus 8.5%, all p <0.001. In conclusion, the 5-year MI or revascularization risk can be considered very low for CCTA-examined patients without ischemic events within 180 days post-CCTA. Conversely, CCTA-examined patients with MI or revascularization events within 180 days post-CCTA have significantly elevated 5-year MI or revascularization risk.

Original languageEnglish
JournalThe American Journal of Cardiology
Volume176
Pages (from-to)1-7
Number of pages7
ISSN0002-9149
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

Keywords

  • Computed Tomography Angiography
  • Coronary Angiography/methods
  • Coronary Artery Disease/diagnostic imaging
  • Denmark/epidemiology
  • Follow-Up Studies
  • Humans
  • Myocardial Infarction/epidemiology
  • Myocardial Revascularization

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