Document Detail


Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography.
MedLine Citation:
PMID:  18929245     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (> or =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.
Authors:
Matthew P Ostrom; Ambarish Gopal; Naser Ahmadi; Khurram Nasir; Eric Yang; Ioannis Kakadiaris; Ferdinand Flores; Song S Mao; Matthew J Budoff
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  52     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-20     Completed Date:  2008-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1335-43     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Aged, 80 and over
Cause of Death*
Cohort Studies
Confidence Intervals
Contrast Media / pharmacology
Coronary Angiography / methods*
Coronary Artery Disease / mortality*,  physiopathology,  radiography*
Female
Humans
Incidence
Kaplan-Meiers Estimate
Male
Middle Aged
Predictive Value of Tests
Prognosis
Proportional Hazards Models
ROC Curve
Radiographic Image Enhancement*
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Sex Factors
Survival Analysis
Tomography, X-Ray Computed / methods*
Chemical
Reg. No./Substance:
0/Contrast Media
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2008 Oct 14;52(16):1344-6   [PMID:  18929246 ]

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


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