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Prognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients without Known Cardiac Disease or Chest Pain: The Assessment of Coronary Artery Disease in Stroke Patients Study.
Korean J Radiol. 2020 09; 21(9):1055-1064.KJ

Abstract

OBJECTIVE

To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison to a clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemic stroke patients without chest pain.

MATERIALS AND METHODS

This retrospective study included 1418 patients with acute stroke who had no previous cardiac disease and underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) were assessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed: low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognostic value of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS.

RESULTS

The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%, respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS, and stenosis degree were positively associated with MACE (all p < 0.05). Patients with high-risk plaque type showed the highest incidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p < 0.001). Among the prediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared to FRS or the FRS + CACS model (all p < 0.05). Furthermore, incorporating plaque type in the prediction model significantly improved reclassification (integrated discrimination improvement, 0.08; p = 0.023) and showed the highest discrimination index (C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p > 0.05).

CONCLUSION

Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS and FRS to risk stratify stroke patients without prior history of CAD better.

Authors+Show Affiliations

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea.Department of Applied Statistics, College of Business and Economics, Yonsei University, Seoul, Korea.Department of Applied Statistics, College of Business and Economics, Yonsei University, Seoul, Korea.Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Department of Internal Medicine, Samsung Medical Center, Seoul, Korea.Department of Radiology, CHA University Bundang Medical Center, Seongnam, Korea.Department of Radiology, University of Maryland, Baltimore, MD, USA.Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea. drejchun@hanmail.net.

Pub Type(s)

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

Language

eng

PubMed ID

32691541

Citation

Yoon, Sung Hyun, et al. "Prognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients Without Known Cardiac Disease or Chest Pain: the Assessment of Coronary Artery Disease in Stroke Patients Study." Korean Journal of Radiology, vol. 21, no. 9, 2020, pp. 1055-1064.
Yoon SH, Kim E, Jeon Y, et al. Prognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients without Known Cardiac Disease or Chest Pain: The Assessment of Coronary Artery Disease in Stroke Patients Study. Korean J Radiol. 2020;21(9):1055-1064.
Yoon, S. H., Kim, E., Jeon, Y., Yi, S. Y., Bae, H. J., Jang, I. K., Lee, J. M., Yoo, S. M., White, C. S., & Chun, E. J. (2020). Prognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients without Known Cardiac Disease or Chest Pain: The Assessment of Coronary Artery Disease in Stroke Patients Study. Korean Journal of Radiology, 21(9), 1055-1064. https://doi.org/10.3348/kjr.2020.0103
Yoon SH, et al. Prognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients Without Known Cardiac Disease or Chest Pain: the Assessment of Coronary Artery Disease in Stroke Patients Study. Korean J Radiol. 2020;21(9):1055-1064. PubMed PMID: 32691541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients without Known Cardiac Disease or Chest Pain: The Assessment of Coronary Artery Disease in Stroke Patients Study. AU - Yoon,Sung Hyun, AU - Kim,Eunhee, AU - Jeon,Yongho, AU - Yi,Sang Yoon, AU - Bae,Hee Joon, AU - Jang,Ik Kyung, AU - Lee,Joo Myung, AU - Yoo,Seung Min, AU - White,Charles S, AU - Chun,Eun Ju, PY - 2020/02/08/received PY - 2020/04/10/revised PY - 2020/04/28/accepted PY - 2020/7/22/entrez PY - 2020/7/22/pubmed PY - 2020/7/22/medline KW - Coronary artery calcium scoring KW - Coronary computed tomography angiography KW - Coronary stenosis KW - Plaque, atherosclerotic KW - Stroke SP - 1055 EP - 1064 JF - Korean journal of radiology JO - Korean J Radiol VL - 21 IS - 9 N2 - OBJECTIVE: To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison to a clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemic stroke patients without chest pain. MATERIALS AND METHODS: This retrospective study included 1418 patients with acute stroke who had no previous cardiac disease and underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) were assessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed: low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognostic value of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. RESULTS: The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%, respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS, and stenosis degree were positively associated with MACE (all p < 0.05). Patients with high-risk plaque type showed the highest incidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p < 0.001). Among the prediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared to FRS or the FRS + CACS model (all p < 0.05). Furthermore, incorporating plaque type in the prediction model significantly improved reclassification (integrated discrimination improvement, 0.08; p = 0.023) and showed the highest discrimination index (C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p > 0.05). CONCLUSION: Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS and FRS to risk stratify stroke patients without prior history of CAD better. SN - 2005-8330 UR - https://www.unboundmedicine.com/medline/citation/32691541/Prognostic_Value_of_Coronary_CT_Angiography_for_Predicting_Poor_Cardiac_Outcome_in_Stroke_Patients_without_Known_Cardiac_Disease_or_Chest_Pain:_The_Assessment_of_Coronary_Artery_Disease_in_Stroke_Patients_Study_ DB - PRIME DP - Unbound Medicine ER -