Document Detail


Incremental prognostic value of coronary CT angiography in patients with suspected coronary artery disease.
MedLine Citation:
PMID:  20460497     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Multidetector CT coronary angiography (MDCTCA) is capable of detecting coronary artery disease (CAD) with a high diagnostic accuracy. In particular, this technique is credited with having a negative predictive value close to 100%. However, data about the prognostic value of MDCTCA are currently lacking. We sought to determine the prognostic value of MDCTCA in patients with suspected but undocumented CAD and, in particular, the incremental prognostic value as compared with clinical risk and calcium scoring.
METHODS AND RESULTS: A total of 441 patients (age, 59.7+/-11.6 years) with suspected CAD underwent MDCTCA to evaluate the presence and severity of the disease. Patients were followed up as to the occurrence of hard cardiac events (cardiac death, nonfatal myocardial infarction, and unstable angina requiring hospitalization). Coronary lesions were detected in 297 (67.3%) patients. During a mean follow-up of 31.9+/-14.8 months, 44 hard cardiac events occurred in 40 patients. CT calcium scoring showed a statistically significant incremental prognostic value as compared to a baseline clinical risk model (P=0.018), whereas MDCTCA provided an additional incremental prognostic value as compared with a baseline clinical risk model plus calcium scoring if considering both nonobstructive versus obstructive CAD (P=0.016) or, better, plaque composition (calcified versus noncalcified and/or mixed plaques, P=0.0001). During follow-up, an excellent prognosis was noted in patients with normal coronary arteries, with an annualized incidence rate of 0.88% if compared with those with mild CAD (3.89%) and with patients with significant coronary disease (8.09%). The presence of noncalcified or mixed plaques, regardless of lesion severity, was found to be the strongest predictor of events (P<0.0001) as a potential marker of plaque vulnerability.
CONCLUSIONS: MDCTCA provides independent and incremental prognostic information as compared to baseline clinical risk factors and calcium scoring in patients with suspected CAD.
Authors:
Vincenzo Russo; Andrea Zavalloni; Maria Letizia Bacchi Reggiani; Katia Buttazzi; Valentina Gostoli; Simone Bartolini; Rossella Fattori
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Publication Detail:
Type:  Journal Article     Date:  2010-05-11
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-21     Completed Date:  2010-08-12     Revised Date:  2011-09-06    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  351-9     Citation Subset:  IM    
Affiliation:
Cardio-Thoracic-Vascular Department, Cardiovascular Radiology Unit, and Cardiology Institute, University Hospital S. Orsola, Via Massarenti 9, Bologna, Italy. virusso@fastwebnet.it
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MeSH Terms
Descriptor/Qualifier:
Calcinosis / epidemiology,  radiography
Chi-Square Distribution
Coronary Angiography / methods*
Coronary Artery Disease / epidemiology,  radiography*
Female
Humans
Incidence
Interviews as Topic
Male
Middle Aged
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Risk Factors
Severity of Illness Index
Tomography, X-Ray Computed / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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