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Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients.
JACC Cardiovasc Imaging. 2012 Oct; 5(10):990-9.JC

Abstract

OBJECTIVES

This study sought to evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CTA) for major adverse cardiac events (MACE).

BACKGROUND

The prognostic value of CACS has been well described. Few studies use the rich information of coronary CTA to predict future clinical outcomes and compare CACS with coronary CTA.

METHODS

We followed up 5,007 outpatients who were suspected of having coronary artery disease (CAD) and who underwent cardiac CTA. Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in coronary CTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization.

RESULTS

Follow-up was completed in 4,425 patients (88.4%), with a median follow-up period of 1,081 days. At the end of the follow-up period, 363 (8.2%) patients had experienced MACE. Cumulative probability of 3-year MACE increased across CT strata for CACS (CACS 0, 2.1%; CACS 1 to 100, 12.9%; CACS 101 to 400, 16.3%; and CACS >400, 33.8%; log-rank p < 0.001); for coronary CTA (no plaque 0.8%, nonobstructive disease 3.7%, 1-vessel disease 27.6%, 2-vessel disease 35.5%, and 3-vessel disease 57.7%; log-rank p < 0.001); and for characteristics of the plaques (5.5% for calcified plaque, 22.7% for noncalcified plaque, and 37.7% for mixed plaque; log-rank p < 0.001). The area under the receiver-operating characteristic curves showed the incremental value of CACS and coronary CTA for predicting MACE: 0.71 for clinical risk factors, which improved to 0.82 by adding CACS and further improved to 0.93 by adding coronary CTA (both p < 0.001).

CONCLUSIONS

The CACS and coronary CTA findings have prognostic value and have incremental value over routine risk factors for MACE, and coronary CTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value.

Authors+Show Affiliations

Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23058065

Citation

Hou, Zhi-hui, et al. "Prognostic Value of Coronary CT Angiography and Calcium Score for Major Adverse Cardiac Events in Outpatients." JACC. Cardiovascular Imaging, vol. 5, no. 10, 2012, pp. 990-9.
Hou ZH, Lu B, Gao Y, et al. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC Cardiovasc Imaging. 2012;5(10):990-9.
Hou, Z. H., Lu, B., Gao, Y., Jiang, S. L., Wang, Y., Li, W., & Budoff, M. J. (2012). Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC. Cardiovascular Imaging, 5(10), 990-9. https://doi.org/10.1016/j.jcmg.2012.06.006
Hou ZH, et al. Prognostic Value of Coronary CT Angiography and Calcium Score for Major Adverse Cardiac Events in Outpatients. JACC Cardiovasc Imaging. 2012;5(10):990-9. PubMed PMID: 23058065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. AU - Hou,Zhi-hui, AU - Lu,Bin, AU - Gao,Yang, AU - Jiang,Shi-liang, AU - Wang,Yang, AU - Li,Wei, AU - Budoff,Matthew J, PY - 2012/03/07/received PY - 2012/06/04/revised PY - 2012/06/14/accepted PY - 2012/10/13/entrez PY - 2012/10/13/pubmed PY - 2013/3/26/medline SP - 990 EP - 9 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 5 IS - 10 N2 - OBJECTIVES: This study sought to evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CTA) for major adverse cardiac events (MACE). BACKGROUND: The prognostic value of CACS has been well described. Few studies use the rich information of coronary CTA to predict future clinical outcomes and compare CACS with coronary CTA. METHODS: We followed up 5,007 outpatients who were suspected of having coronary artery disease (CAD) and who underwent cardiac CTA. Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in coronary CTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. RESULTS: Follow-up was completed in 4,425 patients (88.4%), with a median follow-up period of 1,081 days. At the end of the follow-up period, 363 (8.2%) patients had experienced MACE. Cumulative probability of 3-year MACE increased across CT strata for CACS (CACS 0, 2.1%; CACS 1 to 100, 12.9%; CACS 101 to 400, 16.3%; and CACS >400, 33.8%; log-rank p < 0.001); for coronary CTA (no plaque 0.8%, nonobstructive disease 3.7%, 1-vessel disease 27.6%, 2-vessel disease 35.5%, and 3-vessel disease 57.7%; log-rank p < 0.001); and for characteristics of the plaques (5.5% for calcified plaque, 22.7% for noncalcified plaque, and 37.7% for mixed plaque; log-rank p < 0.001). The area under the receiver-operating characteristic curves showed the incremental value of CACS and coronary CTA for predicting MACE: 0.71 for clinical risk factors, which improved to 0.82 by adding CACS and further improved to 0.93 by adding coronary CTA (both p < 0.001). CONCLUSIONS: The CACS and coronary CTA findings have prognostic value and have incremental value over routine risk factors for MACE, and coronary CTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/23058065/Prognostic_value_of_coronary_CT_angiography_and_calcium_score_for_major_adverse_cardiac_events_in_outpatients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(12)00598-0 DB - PRIME DP - Unbound Medicine ER -