Prognostic Value of Multidetector Coronary Computed Tomographic Angiography for Prediction of All-Cause Mortality
James K. Min, MD*, ,*,
Leslee J. Shaw, PhD ,
Richard B. Devereux, MD*,
Peter M. Okin, MD*,
Jonathan W. Weinsaft, MD*,
Donald J. Russo, MD,
Nicholas J. Lippolis, MD,
Daniel S. Berman, MD and
Tracy Q. Callister, MD
* Greenberg Division of Cardiology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
Tennessee Heart and Vascular Institute, Hendersonville, Tennessee
Cedars-Sinai Medical Center, Los Angeles, California.
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Figure 1 Grading of Plaque Severity
(A) Examples of moderate and severe extent of noncalcified plaque of the left anterior descending artery. (B) Examples of mild, moderate, and severe extent of mixed plaque of the left anterior descending artery. (C) Examples of mild, moderate, and severe extent of calcified plaque of the left anterior descending artery. Arrows indicate coronary artery plaque.
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Figure 2 Coronary Artery Tree Model Depicting Coronary Artery Plaque Scores
Segment stenosis score was calculated by summation of moderate plaque in the proximal right coronary artery (2) + mild plaque in the proximal left anterior descending artery (1) + moderate plaque in the mid left anterior descending artery (2) + severe plaque in the proximal right coronary artery (3). In this example, the segment stenosis score is 8 out of a possible 48. Segment involvement score was calculated by summation of the absolute number of coronary segments exhibiting plaque, i.e., the proximal right coronary artery (1) + proximal left anterior descending artery (1) + mid left anterior descending artery (1) + proximal right coronary artery (1). In this example, the segment involvement score is 4 out of a possible 16. Three-vessel plaque score was calculated as a binary variable to indicate the presence or absence of 3-vessel coronary artery plaque. Three-vessel plaque score was considered positive if there was concurrent presence of plaque in the left anterior descending artery, left circumflex artery, and right coronary artery. In this example, the 3-vessel plaque score is 1 out of a possible 1. Severe proximal plaque score was measured by presence of severe plaque in the proximal portion of the left anterior descending artery, left circumflex artery, or right coronary artery. In this example, the severe proximal plaque score is 1 out of a possible 3. Left main plaque is measured by any plaque within the left main artery. In this example, the left main plaque score is 0 out of a possible 1.
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Figure 3 Cumulative Survival in Patients With Moderate (>50%) Plaque by CCTA
Risk-adjusted p < 0.001 (controlling for age, family history, and dyslipidemia). CCTA = coronary computed tomographic angiography
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Figure 4 Cumulative Survival in Patients With Severe Plaque or Moderate/Severe Left Main Plaque by CCTA
Risk-adjusted p < 0.001 (controlling for age, family history, and dyslipidemia). CCTA = coronary computed tomographic angiography.
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Figure 5 Cumulative Survival in Patients With Proximal Left Anterior Descending Artery Plaque by CCTA
Risk-adjusted p < 0.001 (controlling for age, family history, and dyslipidemia). CCTA = coronary computed tomographic angiography.
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Figure 6 Cumulative Survival in Patients Exhibiting Plaque by the Duke Prognostic Coronary Artery Disease Index
Risk-adjusted p < 0.001 (controlling for age, family history, and dyslipidemia). LAD = left anterior descending artery.
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