CORRESPONDENCE: LETTER TO THE EDITOR
Reply
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
* 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).
We thank Drs. Suhar, Hitchcock, Russo, and Topol for their interest in our recent report of the prognostic value of coronary computed tomographic angiography (CCTA) for the prediction of all-cause death (1). Suhar and colleagues raise the possibility that most patients in our study population with moderate to severe triple-vessel coronary artery disease may have undergone coronary revascularization that might have affected their mortality. In response to this important question, we have further evaluated data now available to us at the primary sites from which patients were referred. Among the 106 patients with CCTA-identified moderate to severe 3-vessel coronary artery disease (defined by severe plaque in the proximal or midportions of the left anterior descending artery/diagonal branch and left circumflex artery/obtuse marginal branch and right coronary artery, or moderate to severe plaque in the left main artery), 37 underwent subsequent invasive coronary angiography, with 6 undergoing percutaneous or surgical revascularization. No significant difference existed in all-cause mortality between the small groups of patients who underwent invasive angiography or coronary revascularization and the larger number who did not (both p > 0.20 in univariate analyses).
As Suhar and colleagues also correctly note, these results represent intermediate-term outcomes based upon CCTA findings from 16-slice CCTA scans, for which long-term mortality data is only just beginning to unfold (2). Our study represents the scaling of only the first of many hurdles to come. Future prognostic series examining the efficacy of current generation 64-slice CCTA plaque identification for the prediction of future adverse outcome, including major cardiovascular events other than death, are necessary at this early stage in the field. Furthermore, additional information that can be routinely gleaned from a typical CCTA examination, including plaque composition patterns (3); cardiac chamber function, volumes, and mass (4); and myocardial attenuation densities (5) should be studied to determine which of these, if any, provide incremental prognostic utility in those subjects more prone to death. We hope that our initial study will encourage such research so that the entirety of CCTA data can be incorporated into making optimal treatment decisions that can benefit all patients.
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1. Min J, Shaw L, Devereux R, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality J Am Coll Cardiol 2007;50:1161-1170.[Abstract/Free Full Text]2. Ostrum MP, Yang E, Mao S, Gopal A, Ahmadi N, Budoff MJ. Mortality incidence and the severity of coronary atherosclerosis assessed by CT angiography(abstr) Circulation 2007;116:II771. 3. Cordeiro MA, Lima JA. Atherosclerotic plaque characterization by multidetector row computed tomography J Am Coll Cardiol 2006(47 Suppl 8):C40-C47. 4. van der Vleuten PA, Willems TP, Gotte MJ, et al. Quantification of global left ventricular function: comparison of multidetector computed tomography and magnetic resonance imaging: a meta-analysis and review of the current literature Acta Radiol 2006;47:1049-1057.[CrossRef][Web of Science][Medline] 5. Cury RC, Nieman K, Shapiro, MD, Nasir K, Cury RC, Brady TJ. Comprehensive cardiac CT study: evaluation of coronary arteries, left ventricular function, and myocardial perfusion—is it possible? J Nucl Cardiol 2007;14:229-243.[CrossRef][Web of Science][Medline]
Related Article
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Is Computed Tomographic Angiography Prognostic in Patients With Cardiac Symptoms?
- Christopher J. Suhar, Todd M. Hitchcock, Robert J. Russo, and Eric J. Topol
J. Am. Coll. Cardiol. 2008 51: 1510.
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