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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography
Matthew P Ostrom1, Ambarish Gopal, Naser Ahmadi
1Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.
Insights
Cardiac computed tomography angiography (CTA) effectively predicts all-cause mortality in symptomatic patients. The extent of coronary artery disease (CAD) identified by CTA offers significant prognostic value, independent of traditional risk factors and coronary artery calcification (CAC).
Area of Science:
- Cardiovascular imaging
- Diagnostic accuracy
- Prognostic modeling
Background:
- Coronary artery disease (CAD) assessment increasingly utilizes noninvasive coronary computed tomography angiography (CTA).
- Limited outcome data exist for CTA in predicting mortality.
- Electron beam tomography enabled extended follow-up (up to 12 years) for outcome analysis.
Purpose of the Study:
- To investigate the predictive capability of cardiac CTA for all-cause mortality in symptomatic individuals.
- To evaluate the incremental prognostic value of CTA-diagnosed CAD beyond traditional risk factors and coronary artery calcification (CAC).
Main Methods:
- 2,538 consecutive symptomatic patients without known CAD underwent CTA via electron beam tomography.
- Coronary CTA results were classified as significant CAD (>50% narrowing), mild CAD (<50% stenosis), or normal.
- Multivariable Cox proportional hazards models, incorporating traditional risk factors and CAC, were used to predict all-cause mortality.
Main Results:
- During a mean follow-up of 78 months, 86 deaths (3.4%) occurred.
- CTA-diagnosed CAD independently predicted mortality (p < 0.0001), even after adjusting for risk factors and CAC.
- The addition of CAC to CTA significantly improved the prediction model's concordance index (0.89).
- Hazard ratios for mortality increased with the extent of CTA-diagnosed CAD, from nonobstructive to 3-vessel obstructive disease.
Conclusions:
- The burden of angiographic disease identified by CTA is an independent predictor of all-cause mortality in symptomatic patients.
- CTA provides incremental prognostic value for mortality prediction, surpassing traditional risk factors and CAC alone.
- Cardiac CTA is a valuable tool for risk stratification in symptomatic individuals with suspected coronary artery disease.
Objectives:
This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients.
Background:
Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies.
Methods:
In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 +/- 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (> or =50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC).
Results:
During a mean follow-up of 78 +/- 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD.
Conclusions:
The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.
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