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Long-term prognostic effect of coronary atherosclerotic burden: validation of the computed tomography-Leaman score.
Circ Cardiovasc Imaging. 2015 Feb; 8(2):e002332.CC

Abstract

BACKGROUND

Computed tomography-adapted Leaman score (CT-LeSc) was developed to quantify coronary CT angiography information about atherosclerotic burden (lesion localization, stenosis degree, and plaque composition). The objective of the study is to evaluate CT-LeSc long-term prognostic value in patients with suspected coronary artery disease (CAD).

METHODS AND RESULTS

Single-center prospective registry including 1304 consecutive patients undergoing coronary CT angiography for suspected CAD. High CT-LeSc was defined by upper tertile (score, >5) cutoff. Segment involvement score and segment stenosis score were also evaluated. Hard cardiac events (cardiac death and nonfatal acute coronary syndromes) were considered for analysis. Different Cox regression models were used to identify independent event predictors. Kaplan-Meier event-free survival was evaluated in 4 patient subgroups stratified by obstructive (≥50% stenosis) versus nonobstructive CAD and a high (>5) versus a low (≤5) CT-LeSc. Of 1196 patients included in the final analysis (mean follow-up of 52±22 months), 125 patients experienced 136 hard events (18 cardiac deaths and 118 nonfatal myocardial infarction). All atherosclerotic burden scores were independent predictors of cardiac events (hazard ratios of 3.09 for segment involvement score, 4.42 for segment stenosis score, and 5.39 for CT-LeSc). Cumulative event-free survival was 76.8% with a high CT-LeSc and 96.0% with a low CT-LeSc. Event-free survival in nonobstructive CAD with high CT-LeSc (78.6%) was similar to obstructive CAD with high CT-LeSc (76.5%) but lower than obstructive CAD with low CT-LeSc (80.7%).

CONCLUSIONS

CT-LeSc is an independent long-term predictor of hard cardiac events. Patients with nonobstructive CAD and high CT-LeSc had hard event-free survival similar to patients with obstructive CAD.

Authors+Show Affiliations

From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.).From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., G.P., A.L.B., E.B., M.P., D.A.); Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal (P.D.A.G.); Cardiovascular Center, Hospital da Luz, ESS, Lisbon, Portugal (P.D.A.G.); CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal (P.D.A.G.); Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (H.M.G.-G., C.M.C., P.W.S.); Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (A.L.B., D.A.); and Department of Cardiology, Imperial College London, London, United Kingdom (P.W.S.). daniele.andreini@ccfm.it.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

25666717

Citation

Mushtaq, Saima, et al. "Long-term Prognostic Effect of Coronary Atherosclerotic Burden: Validation of the Computed tomography-Leaman Score." Circulation. Cardiovascular Imaging, vol. 8, no. 2, 2015, pp. e002332.
Mushtaq S, De Araujo Gonçalves P, Garcia-Garcia HM, et al. Long-term prognostic effect of coronary atherosclerotic burden: validation of the computed tomography-Leaman score. Circ Cardiovasc Imaging. 2015;8(2):e002332.
Mushtaq, S., De Araujo Gonçalves, P., Garcia-Garcia, H. M., Pontone, G., Bartorelli, A. L., Bertella, E., Campos, C. M., Pepi, M., Serruys, P. W., & Andreini, D. (2015). Long-term prognostic effect of coronary atherosclerotic burden: validation of the computed tomography-Leaman score. Circulation. Cardiovascular Imaging, 8(2), e002332. https://doi.org/10.1161/CIRCIMAGING.114.002332
Mushtaq S, et al. Long-term Prognostic Effect of Coronary Atherosclerotic Burden: Validation of the Computed tomography-Leaman Score. Circ Cardiovasc Imaging. 2015;8(2):e002332. PubMed PMID: 25666717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term prognostic effect of coronary atherosclerotic burden: validation of the computed tomography-Leaman score. AU - Mushtaq,Saima, AU - De Araujo Gonçalves,Pedro, AU - Garcia-Garcia,Hector M, AU - Pontone,Gianluca, AU - Bartorelli,Antonio L, AU - Bertella,Erika, AU - Campos,Carlos M, AU - Pepi,Mauro, AU - Serruys,Patrick W, AU - Andreini,Daniele, PY - 2015/2/11/entrez PY - 2015/2/11/pubmed PY - 2015/3/19/medline KW - computed tomography KW - coronary artery disease KW - prognosis SP - e002332 EP - e002332 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 8 IS - 2 N2 - BACKGROUND: Computed tomography-adapted Leaman score (CT-LeSc) was developed to quantify coronary CT angiography information about atherosclerotic burden (lesion localization, stenosis degree, and plaque composition). The objective of the study is to evaluate CT-LeSc long-term prognostic value in patients with suspected coronary artery disease (CAD). METHODS AND RESULTS: Single-center prospective registry including 1304 consecutive patients undergoing coronary CT angiography for suspected CAD. High CT-LeSc was defined by upper tertile (score, >5) cutoff. Segment involvement score and segment stenosis score were also evaluated. Hard cardiac events (cardiac death and nonfatal acute coronary syndromes) were considered for analysis. Different Cox regression models were used to identify independent event predictors. Kaplan-Meier event-free survival was evaluated in 4 patient subgroups stratified by obstructive (≥50% stenosis) versus nonobstructive CAD and a high (>5) versus a low (≤5) CT-LeSc. Of 1196 patients included in the final analysis (mean follow-up of 52±22 months), 125 patients experienced 136 hard events (18 cardiac deaths and 118 nonfatal myocardial infarction). All atherosclerotic burden scores were independent predictors of cardiac events (hazard ratios of 3.09 for segment involvement score, 4.42 for segment stenosis score, and 5.39 for CT-LeSc). Cumulative event-free survival was 76.8% with a high CT-LeSc and 96.0% with a low CT-LeSc. Event-free survival in nonobstructive CAD with high CT-LeSc (78.6%) was similar to obstructive CAD with high CT-LeSc (76.5%) but lower than obstructive CAD with low CT-LeSc (80.7%). CONCLUSIONS: CT-LeSc is an independent long-term predictor of hard cardiac events. Patients with nonobstructive CAD and high CT-LeSc had hard event-free survival similar to patients with obstructive CAD. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/25666717/Long_term_prognostic_effect_of_coronary_atherosclerotic_burden:_validation_of_the_computed_tomography_Leaman_score_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.114.002332?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -