Response to: Prognostic Value of Coronary CT Angiography for Cardiac Events

We thank Dr Li and colleagues for their interest and comments with regard to our article. In their letter, the authors point out that the pathogenesis of unstable angina pectoris differs largely from that of stable angina pectoris. Indeed, certain plaque characteristics are believed to be important predictors of outcome in patients with unstable angina pectoris. Coronary CT angiography can help identify some of these characteristics, such as low attenuation and positive remodeling, as potential markers of culprit lesions in acute coronary syndromes. We agree with Dr Li and colleagues that these characteristics should be taken into account when determining the prognostic value of coronary CT angiography in patients with unstable angina pectoris. However, in our study we examined only patients with symptoms of stable angina without a history of coronary artery disease who had been referred by their general practitioner. At baseline, 136 patients (32%) presented with typical angina pectoris, 222 (52%) with atypical angina pectoris, and 66 (16%) with nonanginal chest pain (see supplementary table E1 from our article, online). The study did not include patients with unstable angina at baseline. Although evidence is emerging that certain plaque characteristics also have prognostic value in patients with stable angina pectoris, further research is still warranted.