Tags

Type your tag names separated by a space and hit enter

Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization.
Arch Cardiovasc Dis. 2016 Jun-Jul; 109(6-7):412-21.AC

Abstract

BACKGROUND

The predictive value of CCTA to predict coronary artery disease is high in particular in the absence of coronary calcification. However, the consideration of both CCTA and the calcium score, in addition to the risk factors to determine the indication for coronary revascularization, has not been yet studied.

MATERIALS AND METHODS

This study included 2302 patients (mean age: 60±9.8 years, 46% men), without known coronary artery disease (CAD), who underwent 320-row CCTA. Logistic regression, c-statistic and net reclassification improvement (NRI) were used to assess the role of coronary artery calcium score (CACS) in predicting revascularization after CCTA.

RESULTS

The revascularization rates were 0.75% in patients with a CACS of 0, and there were no adverse events during the follow-up period. The revascularization rates were 3.3% in patients with a CACS of 1-99, 15.4% in patients with a CACS of 100-399, 25.6% in patients with a CACS of 400-999, and 42.4% in patients with a CACS≥1000. The crude and adjusted odds ratios (95% confidence interval) for revascularization per CACS group category were 2.89 (2.53-2.3) and 2.71 (2.33-3.15), respectively; the area under the ROC curve (AUC) was 0.85 (0.83-0.88). The addition of CACS to conventional risk factors improved the accuracy of risk prediction model for revascularization (AUC 0.74 vs 0.63, P=0.001), but it did not reclassify a substantial proportion of patients with positive CACS to risk categories (NRI=-0.023, P=0.66).

CONCLUSIONS

The 320-row CCTA might rule out CAD in low- to intermediate-risk patients. However, its accuracy in identifying patients who require revascularization is limited. The CACS added to the conventional risk factors did not improve the identification of patients who require revascularization.

Authors+Show Affiliations

University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark; Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark. Electronic address: graurb@rm.dk.University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark; Viborg Hospital, Department of Vascular Surgery, Viborg, Denmark.University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark; Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27215378

Citation

Urbonaviciene, Grazina, et al. "Coronary Computed Tomography Angiography and Calcium Scoring in Routine Clinical Practice for Identification of Patients Who Require Revascularization." Archives of Cardiovascular Diseases, vol. 109, no. 6-7, 2016, pp. 412-21.
Urbonaviciene G, Isaksen C, Urbonavicius S, et al. Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization. Arch Cardiovasc Dis. 2016;109(6-7):412-21.
Urbonaviciene, G., Isaksen, C., Urbonavicius, S., Buhl, J. S., Johansen, J. K., Nielsen, A. H., Nørgaard, K. S., Nørgaard, A., & Frost, L. (2016). Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization. Archives of Cardiovascular Diseases, 109(6-7), 412-21. https://doi.org/10.1016/j.acvd.2016.01.013
Urbonaviciene G, et al. Coronary Computed Tomography Angiography and Calcium Scoring in Routine Clinical Practice for Identification of Patients Who Require Revascularization. Arch Cardiovasc Dis. 2016 Jun-Jul;109(6-7):412-21. PubMed PMID: 27215378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization. AU - Urbonaviciene,Grazina, AU - Isaksen,Christin, AU - Urbonavicius,Sigitas, AU - Buhl,Jørgen Selmer, AU - Johansen,Jane Kirk, AU - Nielsen,Agnete Hedemann, AU - Nørgaard,Kirsten Schou, AU - Nørgaard,Aage, AU - Frost,Lars, Y1 - 2016/05/20/ PY - 2015/05/25/received PY - 2015/10/25/revised PY - 2016/01/20/accepted PY - 2016/5/25/entrez PY - 2016/5/25/pubmed PY - 2017/1/31/medline KW - Calcium scoring KW - Coronaroscanner KW - Coronary computed tomography angiography KW - Hemodynamically significant stenosis KW - Revascularisation coronaire KW - Revascularization therapy KW - Score calcique KW - Sténose hémodynamiquement significative SP - 412 EP - 21 JF - Archives of cardiovascular diseases JO - Arch Cardiovasc Dis VL - 109 IS - 6-7 N2 - BACKGROUND: The predictive value of CCTA to predict coronary artery disease is high in particular in the absence of coronary calcification. However, the consideration of both CCTA and the calcium score, in addition to the risk factors to determine the indication for coronary revascularization, has not been yet studied. MATERIALS AND METHODS: This study included 2302 patients (mean age: 60±9.8 years, 46% men), without known coronary artery disease (CAD), who underwent 320-row CCTA. Logistic regression, c-statistic and net reclassification improvement (NRI) were used to assess the role of coronary artery calcium score (CACS) in predicting revascularization after CCTA. RESULTS: The revascularization rates were 0.75% in patients with a CACS of 0, and there were no adverse events during the follow-up period. The revascularization rates were 3.3% in patients with a CACS of 1-99, 15.4% in patients with a CACS of 100-399, 25.6% in patients with a CACS of 400-999, and 42.4% in patients with a CACS≥1000. The crude and adjusted odds ratios (95% confidence interval) for revascularization per CACS group category were 2.89 (2.53-2.3) and 2.71 (2.33-3.15), respectively; the area under the ROC curve (AUC) was 0.85 (0.83-0.88). The addition of CACS to conventional risk factors improved the accuracy of risk prediction model for revascularization (AUC 0.74 vs 0.63, P=0.001), but it did not reclassify a substantial proportion of patients with positive CACS to risk categories (NRI=-0.023, P=0.66). CONCLUSIONS: The 320-row CCTA might rule out CAD in low- to intermediate-risk patients. However, its accuracy in identifying patients who require revascularization is limited. The CACS added to the conventional risk factors did not improve the identification of patients who require revascularization. SN - 1875-2128 UR - https://www.unboundmedicine.com/medline/citation/27215378/Coronary_computed_tomography_angiography_and_calcium_scoring_in_routine_clinical_practice_for_identification_of_patients_who_require_revascularization_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1875-2136(16)30065-1 DB - PRIME DP - Unbound Medicine ER -