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J Am Coll Cardiol, 2007; 50:1161-1170, doi:10.1016/j.jacc.2007.03.067 (Published online 31 August 2007).
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

Prognostic Value of Multidetector Coronary Computed Tomographic Angiography for Prediction of All-Cause Mortality

James K. Min, MD*,{dagger},*, Leslee J. Shaw, PhD{ddagger}, Richard B. Devereux, MD*, Peter M. Okin, MD*, Jonathan W. Weinsaft, MD*, Donald J. Russo, MD{dagger}, Nicholas J. Lippolis, MD{dagger}, Daniel S. Berman, MD{ddagger} and Tracy Q. Callister, MD{dagger}

* Greenberg Division of Cardiology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
{dagger} Tennessee Heart and Vascular Institute, Hendersonville, Tennessee
{ddagger} Cedars-Sinai Medical Center, Los Angeles, California.

Manuscript received November 7, 2006; revised manuscript received March 5, 2007, accepted March 20, 2007.

* Reprint requests and correspondence: Dr. James K. Min, Assistant Professor of Medicine, Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, 520 East 70th Street, K415, New York, New York 10021. (Email: jkm2001{at}med.cornell.edu).

Objectives: The purpose of this study was to examine the association of all-cause death with the coronary computed tomographic angiography (CCTA)-defined extent and severity of coronary artery disease (CAD).

Background: The prognostic value of identifying CAD by CCTA remains undefined.

Methods: We examined a single-center consecutive cohort of 1,127 patients ≥45 years old with chest symptoms. Stenosis by CCTA was scored as minimal (<30%), mild (30% to 49%), moderate (50% to 69%), or severe (≥70%) for each coronary artery. Plaque was assessed in 3 ways: 1) moderate or obstructive plaque; 2) CCTA score modified from Duke coronary artery score; and 3) simple clinical scores grading plaque extent and distribution. A 15.3 ± 3.9-month follow-up of all-cause death was assessed using Cox proportional hazards models adjusted for pretest CAD likelihood and risk factors. Deaths were verified by the Social Security Death Index.

Results: The CCTA predictors of death included proximal left anterior descending artery stenosis and number of vessels with ≥50% and ≥70% stenosis (all p < 0.0001). A modified Duke CAD index, an angiographic score integrating proximal CAD, plaque extent, and left main (LM) disease, improved risk stratification (p < 0.0001). Patients with <50% stenosis had the highest survival at 99.7%. Survival worsened with higher-risk Duke scores, ranging from 96% survival for 1 stenosis ≥70% or 2 stenoses ≥50% (p = 0.013) to 85% survival for ≥50% LM artery stenosis (p < 0.0001). Clinical scores measuring plaque burden and distribution predicted 5% to 6% higher absolute death rate (6.6% vs. 1.6% and 8.4% vs. 2.5%; p = 0.05 for both).

Conclusions: In patients with chest pain, CCTA identifies increased risk for all-cause death. Importantly, a negative CCTA portends an extremely low risk for death.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CCTA = coronary computed tomographic angiography


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J. Am. Coll. Cardiol. Img., March 1, 2010; 3(3): 305 - 315.
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J. K. Min, A. Gilmore, M. J. Budoff, D. S. Berman, and K. O'Day
Cost-effectiveness of Coronary CT Angiography versus Myocardial Perfusion SPECT for Evaluation of Patients with Chest Pain and No Known Coronary Artery Disease
Radiology, March 1, 2010; 254(3): 801 - 808.
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K. Goto, A. J. Lansky, M. Fahy, E. Cristea, F. Feit, E. M. Ohman, H. D. White, K. P. Alexander, M. E. Bertrand, W. Desmet, et al.
Predictors of Outcomes in Medically Treated Patients With Acute Coronary Syndromes After Angiographic Triage: An Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) Substudy
Circulation, February 23, 2010; 121(7): 853 - 862.
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I. Gottlieb, J. M. Miller, A. Arbab-Zadeh, M. Dewey, M. E. Clouse, L. Sara, H. Niinuma, D. E. Bush, N. Paul, A. L. Vavere, et al.
The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography
J. Am. Coll. Cardiol., February 16, 2010; 55(7): 627 - 634.
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J E van Velzen, J D Schuijf, F R de Graaf, G Nucifora, G Pundziute, J W Jukema, M J Schalij, L J Kroft, A de Roos, J H C Reiber, et al.
Plaque type and composition as evaluated non-invasively by MSCT angiography and invasively by VH IVUS in relation to the degree of stenosis
Heart, December 15, 2009; 95(24): 1990 - 1996.
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J. M. van Werkhoven, J. D. Schuijf, O. Gaemperli, J. W. Jukema, L. J. Kroft, E. Boersma, A. Pazhenkottil, I. Valenta, G. Pundziute, A. de Roos, et al.
Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease
Eur. Heart J., November 1, 2009; 30(21): 2622 - 2629.
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G. Bastarrika, Y. S. Lee, W. Huda, B. Ruzsics, P. Costello, and U. J. Schoepf
CT of Coronary Artery Disease
Radiology, November 1, 2009; 253(2): 317 - 338.
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K Nieman, T Galema, A Weustink, L Neefjes, A Moelker, P Musters, R de Visser, N Mollet, H Boersma, and P J de Feijter
Computed tomography versus exercise electrocardiography in patients with stable chest complaints: real-world experiences from a fast-track chest pain clinic
Heart, October 15, 2009; 95(20): 1669 - 1675.
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J M van Werkhoven, O Gaemperli, J D Schuijf, J W Jukema, L J Kroft, S Leschka, H Alkadhi, I Valenta, G Pundziute, A de Roos, et al.
Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood
Heart, October 1, 2009; 95(19): 1607 - 1611.
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B. Bischoff, F. Hein, T. Meyer, M. Hadamitzky, S. Martinoff, A. Schomig, and J. Hausleiter
Impact of a Reduced Tube Voltage on CT Angiography and Radiation Dose: Results of the PROTECTION I Study
J. Am. Coll. Cardiol. Img., August 1, 2009; 2(8): 940 - 946.
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L. J. Shaw and J. Narula
Risk Assessment and Predictive Value of Coronary Artery Disease Testing
J. Nucl. Med., August 1, 2009; 50(8): 1296 - 1306.
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J. H.F. Rudd, F. Hyafil, and Z. A. Fayad
Inflammation Imaging in Atherosclerosis
Arterioscler Thromb Vasc Biol, July 1, 2009; 29(7): 1009 - 1016.
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S. Motoyama, M. Sarai, H. Harigaya, H. Anno, K. Inoue, T. Hara, H. Naruse, J. Ishii, H. Hishida, N. D. Wong, et al.
Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome
J. Am. Coll. Cardiol., June 30, 2009; 54(1): 49 - 57.
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S. Achenbach, V. Dilsizian, C. M. Kramer, and W. A. Zoghbi
The Year in Coronary Artery Disease
J. Am. Coll. Cardiol. Img., June 1, 2009; 2(6): 774 - 786.
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U. Hoffmann, F. Bamberg, C. U. Chae, J. H. Nichols, I. S. Rogers, S. K. Seneviratne, Q. A. Truong, R. C. Cury, S. Abbara, M. D. Shapiro, et al.
Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain: The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial
J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1642 - 1650.
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M. Hadamitzky, B. Freissmuth, T. Meyer, F. Hein, A. Kastrati, S. Martinoff, A. Schomig, and J. Hausleiter
Prognostic Value of Coronary Computed Tomographic Angiography for Prediction of Cardiac Events in Patients With Suspected Coronary Artery Disease
J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 404 - 411.
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L. Shaw and J. Narula
Bridging the Detection Gap Chasm of Risk: Where Can Computed Tomography Angiography Take Us?
J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 524 - 526.
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B. Sundaram, S. Patel, N. Bogot, and E. A. Kazerooni
Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 1, Structured Report, Coronary Calcium Screening, and Coronary Artery Anatomy
Am. J. Roentgenol., March 1, 2009; 192(3): 574 - 583.
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J. M. van Werkhoven, J. D. Schuijf, O. Gaemperli, J. W. Jukema, E. Boersma, W. Wijns, P. Stolzmann, H. Alkadhi, I. Valenta, M. P.M. Stokkel, et al.
Prognostic Value of Multislice Computed Tomography and Gated Single-Photon Emission Computed Tomography in Patients With Suspected Coronary Artery Disease
J. Am. Coll. Cardiol., February 17, 2009; 53(7): 623 - 632.
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T. P. Carrigan, D. Nair, P. Schoenhagen, R. J. Curtin, Z. B. Popovic, S. Halliburton, S. Kuzmiak, R. D. White, S. D. Flamm, and M. Y. Desai
Prognostic utility of 64-slice computed tomography in patients with suspected but no documented coronary artery disease
Eur. Heart J., February 1, 2009; 30(3): 362 - 371.
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R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol., January 6, 2009; 53(1): 54 - 70.
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S. Y. Lee, G. S. Mintz, S.-Y. Kim, Y. J. Hong, S. W. Kim, T. Okabe, A. D. Pichard, L. F. Satler, K. M. Kent, W. O. Suddath, et al.
Attenuated Plaque Detected by Intravascular Ultrasound: Clinical, Angiographic, and Morphologic Features and Post-Percutaneous Coronary Intervention Complications in Patients With Acute Coronary Syndromes
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K. M. Johnson, D. A. Dowe, and J. A. Brink
Traditional Clinical Risk Assessment Tools Do Not Accurately Predict Coronary Atherosclerotic Plaque Burden: A CT Angiography Study
Am. J. Roentgenol., January 1, 2009; 192(1): 235 - 243.
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P. J. de Feyter, S. Achenbach, and K. Nieman
CHAPTER 6 Cardiovascular Computed Tomography
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

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W. B. Meijboom, M. F.L. Meijs, J. D. Schuijf, M. J. Cramer, N. R. Mollet, C. A.G. van Mieghem, K. Nieman, J. M. van Werkhoven, G. Pundziute, A. C. Weustink, et al.
Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography: A Prospective, Multicenter, Multivendor Study
J. Am. Coll. Cardiol., December 16, 2008; 52(25): 2135 - 2144.
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F. Y. Lin, R. B. Devereux, M. J. Roman, J. Meng, V. M. Jow, A. Jacobs, J. W. Weinsaft, L. J. Shaw, D. S. Berman, T. Q. Callister, et al.
Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity.
J. Am. Coll. Cardiol. Img., November 1, 2008; 1(6): 782 - 786.
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J. K. Min and L. J. Shaw
Noninvasive Diagnostic and Prognostic Assessment of Individuals With Suspected Coronary Artery Disease: Coronary Computed Tomographic Angiography Perspective
Circ Cardiovasc Imaging, November 1, 2008; 1(3): 270 - 281.
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M. P. Ostrom, A. Gopal, N. Ahmadi, K. Nasir, E. Yang, I. Kakadiaris, F. Flores, S. S. Mao, and M. J. Budoff
Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography
J. Am. Coll. Cardiol., October 14, 2008; 52(16): 1335 - 1343.
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S. Achenbach
Assessing the Prognostic Value of Coronary Computed Tomography Angiography
J. Am. Coll. Cardiol., October 14, 2008; 52(16): 1344 - 1346.
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G. Pundziute, J. D. Schuijf, J. W. Jukema, I. Decramer, G. Sarno, P. K. Vanhoenacker, E. Boersma, J. H.C. Reiber, M. J. Schalij, W. Wijns, et al.
Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis
Eur. Heart J., October 1, 2008; 29(19): 2373 - 2381.
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P. Schoenhagen and E. M. Tuzcu
Identifying patterns of atherosclerotic disease manifestation with coronary computed tomography. Impact on clinical management and outcome?
Eur. Heart J., October 1, 2008; 29(19): 2323 - 2324.
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 RadiologyHome page
J. K. Min, N. Kang, L. J. Shaw, R. B. Devereux, M. Robinson, F. Lin, A. P. Legorreta, and A. Gilmore
Costs and Clinical Outcomes after Coronary Multidetector CT Angiography in Patients without Known Coronary Artery Disease: Comparison to Myocardial Perfusion SPECT1
Radiology, October 1, 2008; 249(1): 62 - 70.
[Abstract] [Full Text] [PDF]

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D. G. Katritsis and B. Meier
Percutaneous Coronary Intervention for Stable Coronary Artery Disease
J. Am. Coll. Cardiol., September 9, 2008; 52(11): 889 - 893.
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