☆ 4.7 Article

Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2008)

期刊

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷 52, 期 16, 页码 1335-1343

出版社

ELSEVIER SCIENCE INC

DOI: 10.1016/j.jacc.2008.07.027

关键词

outcomes; CT angiography; cardiac CT; prognosis; coronary calcium

类别

Cardiac & Cardiovascular Systems

向作者/读者索取更多资源

Protocol

社区支持

Reagent

社区支持

摘要

Objectives This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies. Methods In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 +/- 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (>= 50% luminal narrowing), mild CAD (< 50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC). Results During a mean follow-up of 78 +/- 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD. Conclusions The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.

作者

我是这篇论文的作者

点击您的名字以认领此论文并将其添加到您的个人资料中。

主要评分

4.7

评分不足

次要评分

新颖性

重要性

科学严谨性

评价这篇论文

Debates in cardiac CT: Coronary CT angiography is the best test in asymptomatic patients

Mohammed N. Meah, Pal Maurovich-Horvat, Michelle C. Williams, David E. Newby

Summary: Cardiovascular disease is a major global cause of death, with most myocardial infarctions occurring in asymptomatic individuals. Current methods for identifying individuals at risk of myocardial infarction face challenges, and rely on cardiovascular risk scores and coronary artery calcium scores for prevention. However, these scores are unable to detect early high risk non-calcified plaque. Coronary computed tomography angiography is increasingly being used as an imaging strategy for detecting coronary atherosclerosis in symptomatic patients, allowing for timely treatment. For asymptomatic individuals, it can accurately target treatment for coronary heart disease, surpassing the effectiveness of risk calculators and calcium scoring. The development of techniques such as plaque quantification and characterization in coronary computed tomography angiography has the potential to provide precise cardiovascular disease prevention tools for clinicians.

JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY (2022)