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Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography.
J Am Coll Cardiol. 2008 Oct 14; 52(16):1335-43.JACC

Abstract

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.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18929245

Citation

Ostrom, Matthew P., et al. "Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed By Computed Tomography Angiography." Journal of the American College of Cardiology, vol. 52, no. 16, 2008, pp. 1335-43.
Ostrom MP, Gopal A, Ahmadi N, et al. Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. J Am Coll Cardiol. 2008;52(16):1335-43.
Ostrom, M. P., Gopal, A., Ahmadi, N., Nasir, K., Yang, E., Kakadiaris, I., Flores, F., Mao, S. S., & Budoff, M. J. (2008). Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. Journal of the American College of Cardiology, 52(16), 1335-43. https://doi.org/10.1016/j.jacc.2008.07.027
Ostrom MP, et al. Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed By Computed Tomography Angiography. J Am Coll Cardiol. 2008 Oct 14;52(16):1335-43. PubMed PMID: 18929245.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. AU - Ostrom,Matthew P, AU - Gopal,Ambarish, AU - Ahmadi,Naser, AU - Nasir,Khurram, AU - Yang,Eric, AU - Kakadiaris,Ioannis, AU - Flores,Ferdinand, AU - Mao,Song S, AU - Budoff,Matthew J, PY - 2008/03/03/received PY - 2008/07/11/revised PY - 2008/07/14/accepted PY - 2008/10/22/pubmed PY - 2008/11/5/medline PY - 2008/10/22/entrez SP - 1335 EP - 43 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 52 IS - 16 N2 - 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. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/18929245/Mortality_incidence_and_the_severity_of_coronary_atherosclerosis_assessed_by_computed_tomography_angiography_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)02592-8 DB - PRIME DP - Unbound Medicine ER -