Tags

Type your tag names separated by a space and hit enter

Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease.
Atherosclerosis. 2014 Mar; 233(1):190-5.A

Abstract

OBJECTIVE

To evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients.

METHODS

Retrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥ 50% and ≥ 70% stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization).

RESULTS

Among 1145 included patients, the mean age was 55 ± 12 years and median follow up 2.4 (IQR: 1.5-3.5) years. Overall, 406 (35%) CCTA were normal, 454 (40%) had <50% stenosis, and 285 (25%) had ≥ 50% stenosis. The prevalence of ≥ 70% stenosis was 16%. Among 483 (42%) patients with CAC zero, 395 (82%) had normal CCTA, 81 (17%) <50% stenosis, and 7 (1.5%) ≥ 50% stenosis. 2 (0.4%) patients had ≥ 70% stenosis. For diagnosis of ≥ 50% stenosis, CAC had a sensitivity of 98% and specificity of 55%. The negative predictive value (NPV) for CAC was 99% for ≥ 50% stenosis and 99.6% for ≥ 70% stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥ 50% CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p < 0.001) with CAC versus 0.77 (p = 0.02) with CCTA.

CONCLUSION

Among symptomatic patients with CAC zero, a 1-2% prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years.

Authors+Show Affiliations

Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.Baptist Health South Florida, Miami, FL, USA.Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. Electronic address: rblankstein@partners.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24529143

Citation

Hulten, Edward, et al. "Incremental Prognostic Value of Coronary Artery Calcium Score Versus CT Angiography Among Symptomatic Patients Without Known Coronary Artery Disease." Atherosclerosis, vol. 233, no. 1, 2014, pp. 190-5.
Hulten E, Bittencourt MS, Ghoshhajra B, et al. Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease. Atherosclerosis. 2014;233(1):190-5.
Hulten, E., Bittencourt, M. S., Ghoshhajra, B., O'Leary, D., Christman, M. P., Blaha, M. J., Truong, Q., Nelson, K., Montana, P., Steigner, M., Rybicki, F., Hainer, J., Brady, T. J., Hoffmann, U., Di Carli, M. F., Nasir, K., Abbara, S., & Blankstein, R. (2014). Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease. Atherosclerosis, 233(1), 190-5. https://doi.org/10.1016/j.atherosclerosis.2013.12.029
Hulten E, et al. Incremental Prognostic Value of Coronary Artery Calcium Score Versus CT Angiography Among Symptomatic Patients Without Known Coronary Artery Disease. Atherosclerosis. 2014;233(1):190-5. PubMed PMID: 24529143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease. AU - Hulten,Edward, AU - Bittencourt,Marcio Sommer, AU - Ghoshhajra,Brian, AU - O'Leary,Daniel, AU - Christman,Mitalee P, AU - Blaha,Michael J, AU - Truong,Quynh, AU - Nelson,Kyle, AU - Montana,Philip, AU - Steigner,Michael, AU - Rybicki,Frank, AU - Hainer,Jon, AU - Brady,Thomas J, AU - Hoffmann,Udo, AU - Di Carli,Marcelo F, AU - Nasir,Khurram, AU - Abbara,Suhny, AU - Blankstein,Ron, Y1 - 2014/01/08/ PY - 2013/10/25/received PY - 2013/11/28/revised PY - 2013/12/04/accepted PY - 2014/2/18/entrez PY - 2014/2/18/pubmed PY - 2014/10/17/medline KW - Atherosclerosis KW - Coronary artery calcium score KW - Coronary computed tomography angiography KW - Epidemiology SP - 190 EP - 5 JF - Atherosclerosis JO - Atherosclerosis VL - 233 IS - 1 N2 - OBJECTIVE: To evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients. METHODS: Retrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥ 50% and ≥ 70% stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization). RESULTS: Among 1145 included patients, the mean age was 55 ± 12 years and median follow up 2.4 (IQR: 1.5-3.5) years. Overall, 406 (35%) CCTA were normal, 454 (40%) had <50% stenosis, and 285 (25%) had ≥ 50% stenosis. The prevalence of ≥ 70% stenosis was 16%. Among 483 (42%) patients with CAC zero, 395 (82%) had normal CCTA, 81 (17%) <50% stenosis, and 7 (1.5%) ≥ 50% stenosis. 2 (0.4%) patients had ≥ 70% stenosis. For diagnosis of ≥ 50% stenosis, CAC had a sensitivity of 98% and specificity of 55%. The negative predictive value (NPV) for CAC was 99% for ≥ 50% stenosis and 99.6% for ≥ 70% stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥ 50% CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p < 0.001) with CAC versus 0.77 (p = 0.02) with CCTA. CONCLUSION: Among symptomatic patients with CAC zero, a 1-2% prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/24529143/Incremental_prognostic_value_of_coronary_artery_calcium_score_versus_CT_angiography_among_symptomatic_patients_without_known_coronary_artery_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(13)00782-X DB - PRIME DP - Unbound Medicine ER -