CLINICAL RESEARCH: CARDIAC IMAGING
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
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 |
|
Related Article
-
Computed Tomography Coronary Angiography as an Anatomic Basis for Risk Stratification: Déjà Vu or Something New?
- John J. Mahmarian
J. Am. Coll. Cardiol. 2007 50: 1171-1173.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
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.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Achenbach
Assessing the Prognostic Value of Coronary Computed Tomography Angiography
J. Am. Coll. Cardiol.,
October 14, 2008;
52(16):
1344 - 1346.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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 SPECT
Radiology,
October 1, 2008;
249(1):
62 - 70.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. B. Meijboom, C. A.G. Van Mieghem, N. van Pelt, A. Weustink, F. Pugliese, N. R. Mollet, E. Boersma, E. Regar, R. J. van Geuns, P. J. de Jaegere, et al.
Comprehensive Assessment of Coronary Artery Stenoses: Computed Tomography Coronary Angiography Versus Conventional Coronary Angiography and Correlation With Fractional Flow Reserve in Patients With Stable Angina
J. Am. Coll. Cardiol.,
August 19, 2008;
52(8):
636 - 643.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E.-K. Choi, S. I. Choi, J. J. Rivera, K. Nasir, S.-A. Chang, E. J. Chun, H.-K. Kim, D.-J. Choi, R. S. Blumenthal, and H.-J. Chang
Coronary Computed Tomography Angiography as a Screening Tool for the Detection of Occult Coronary Artery Disease in Asymptomatic Individuals
J. Am. Coll. Cardiol.,
July 29, 2008;
52(5):
357 - 365.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. J. de Feyter and C. J. Schultz
Computed Tomography Coronary Angiography for Screening Asymptomatic Subjects: A Bridge Too Far?
J. Am. Coll. Cardiol.,
July 29, 2008;
52(5):
366 - 368.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W T Roberts, J J Bax, and L C Davies
Cardiac CT and CT coronary angiography: technology and application
Heart,
June 1, 2008;
94(6):
781 - 792.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Hachamovitch and M. F. Di Carli
Methods and Limitations of Assessing New Noninvasive Tests: Part II: Outcomes-Based Validation and Reliability Assessment of Noninvasive Testing
Circulation,
May 27, 2008;
117(21):
2793 - 2801.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Suhar, T. M. Hitchcock, R. J. Russo, and E. J. Topol
Is Computed Tomographic Angiography Prognostic in Patients With Cardiac Symptoms?
J. Am. Coll. Cardiol.,
April 15, 2008;
51(15):
1510 - 1510.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Min, L. J. Shaw, R. B. Devereux, P. M. Okin, J. W. Weinsaft, D. J. Russo, N. J. Lippolis, D. S. Berman, and T. Q. Callister
Reply
J. Am. Coll. Cardiol.,
April 15, 2008;
51(15):
1510 - 1511.
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Gottlieb and J. A.C. Lima
Screening High-Risk Patients With Computed Tomography Angiography
Circulation,
March 11, 2008;
117(10):
1318 - 1332.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Sanz, P. R. Moreno, and V. Fuster
The year in atherothrombosis.
J. Am. Coll. Cardiol.,
March 4, 2008;
51(9):
944 - 955.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Williams, L. J. Shaw, P. Raggi, D. Morris, V. Vaccarino, S. T. Liu, S. R. Weinstein, T. P. Mosler, P. H. Tseng, F. R. Flores, et al.
Prognostic Value of Number and Site of Calcified Coronary Lesions Compared With the Total Score
J. Am. Coll. Cardiol. Img.,
January 1, 2008;
1(1):
61 - 69.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Mahmarian
Computed Tomography Coronary Angiography as an Anatomic Basis for Risk Stratification: Deja Vu or Something New?
J. Am. Coll. Cardiol.,
September 18, 2007;
50(12):
1171 - 1173.
[Full Text]
[PDF]
|
|
|
|
