Computed Tomography in Patients Undergoing Coronary Angiography Long-Term Prognostic Value of Coronary Calcification Detected by Electron-Beam (original) (raw)
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Circulation, 2001
Background Electron-beam CT (EBCT) quantification of coronary artery calcification (CAC) allows noninvasive assessment of coronary atherosclerosis. We undertook a follow-up study to determine whether CAC extent, measured at the time of angiography by EBCT, predicted future hard cardiac events, comprising cardiac death and nonfatal myocardial infarction (MI). We also assessed the potential of selected coronary artery disease (CAD) risk factors, prior CAD event history (MI or revascularization), and angiographic findings (number of diseased vessels and overall disease burden) to predict subsequent hard events. Methods and Results Two hundred eighty-eight patients who underwent contemporaneous coronary angiography and EBCT scanning were contacted after a mean of 6.9 years. Vital status and history of MI during follow-up were determined. Cox proportional hazards models were used to compare the predictive ability of CAC extent with selected CAD risk factors, CAD event history, and angiog...
Use of electron beam tomography data to develop models for prediction of hard coronary events
American Heart Journal, 2001
phase of development may provide relevant prognostic information for the prediction of hard cardiovascular end points (myocardial infarction or cardiac death). Electron beam tomography (EBT) allows the visualization of coronary artery calcification (CAC), a known marker of underlying atherosclerosis. The extent of calcium deposits is estimated by means of a calcium score that bears a close correlation to the atherosclerotic plaque burden. 7-10 Previous investigations have dealt with the prognostic impact of CAC discovered on a screening EBT study with controversial results. Arad et al 11 showed that the odds ratios for a variety of cardiovascular events, including revascularization procedures, stroke, myocardial infarction, and death, range between 20 and 35 in the presence of various degrees of calcification on a screening test. In a recent publication we reported that the majority of asymptomatic patients screened by EBT who have a hard coronary event have high age-and sex-specific calcium score percentiles on their initial scans. 12 Other investigators have questioned the predictive value of CAC, especially for subsequent Prediction of hard coronary artery disease (CAD) events remains difficult in spite of the identification of several risk factors for the development of atherosclerotic heart disease and markers of plaque instability. 1,2 In a pursuit for solutions to this difficult task, investigators have recently focused on several noninvasive imaging modalities with the ability to identify atherosclerotic disease in its preclinical stages. 3-6 The question remains whether discovery of atherosclerotic disease in an early From the Background Prediction of hard cardiac events (myocardial infarction and coronary death) remains difficult in spite of the identification of several relevant risk factors for the development of coronary artery disease (CAD). New indicators of risk might add to our predictive ability. We used measures of coronary artery calcification (CAC) found by electron beam tomography (EBT) imaging to develop prediction models for hard cardiac events alone and in association with traditional risk factors for CAD.
American Journal of Cardiology, 2000
The predictive ability of electron-beam computed tomography (EBCT) for coronary heart disease outcomes, particularly hard coronary outcomes (myocardial infarction or death), has been questioned in asymptomatic populations. Our objective was to synthesize data on the use of EBCT for determining cardiovascular prognosis in asymptomatic populations. Studies were identified using standard systematic review methods. The outcome of interest was relative risk for myocardial infarction or sudden death, and combined events including revascularization. Nine articles met the inclusion criteria, of which 5 were of independent studies. Using meta-analytic techniques to synthesize prognostic data, there was an increased risk (summary risk ratio 8.7, 95% confidence interval 2.7 to 28.1) of a combined outcome of nonfatal myocardial infarction or death or revascularization if the calcium score was above a median score. Similarly, there was an increased risk for hard events: myocardial infarction or death (summary risk ratio 4.2, 95% confidence interval 1.6 to 11.3). However, there was significant heterogeneity in the studies' quality and patient populations. Although EBCT appears to predict combined and hard coronary outcomes similarly in high risk, asymptomatic populations, these results should be interpreted with caution. Further study is needed on the incremental value of EBCT over conventional risk prediction before this test is used in screening asymptomatic populations. ᮊ2000 by Excerpta Medica, Inc.
Long-Term Prognosis Associated With Coronary Calcification
Journal of The American College of Cardiology, 2007
The purpose of this study was to develop risk-adjusted multivariable models that include risk factors and coronary artery calcium (CAC) scores measured with electron-beam tomography in asymptomatic patients for the prediction of all-cause mortality.
Diagnostic cardiac CT for the improvement of cardiovascular event prediction
Deutsches Arzteblatt International, 2023
BackgroundThe aim of the long-term Heinz Nixdorf Recall Study (observation period 20 years) was to establish the extent to which computed tomography (CT) improves the predictability of cardiovascular events relative to determination of risk factors alone.MethodsIn the period 2000–2003, study staff examined 4355 probands (53% of them female) aged 45–75 years with no signs of cardiovascular disease. The Atherosclerotic Cardiovascular Disease (ASCVD) score was calculated on the basis of demographic data and cardiovascular risk factors. Cardiac CT was carried out over the same period and coronary artery calcification (CAC) was graded according to the Agatston score.ResultsThe median duration of follow-up was 18.2 years for men and 17.8 years for women. Myocardial infarction or stroke occurred in 458 (11%) of the 4154 participants with complete data. Overall, estimation of risk using a combination of ASCVD score and CAC grade was superior to the ASCVD score alone—even after 10 and 20 years. Classification into established risk categories improved by 12.2% (95% confidence interval: [5.3%; 18.1%]). In the highest ASCVD risk category, we observed occurrence of a cardiovascular event over 20 years for 14% [5.0%; 23.1%] of probands with a CAC score = 0 but for 34.2% [27.5%; 41.4%] of those with a CAC score ≥ 400. In the lowest ASCVD risk category, an event occurred in 2.4% [1.4%; 3.7%] of probands with a CAC score = 0 and in 23.5% [2.3%; 35.8%] of those with a CAC score ≥ 400.ConclusionEven after 20 years, individual risk prediction is improved by addition of CT-based determination of coronary artery calcification to the ASCVD score. Therefore, assessment of ASCVD risk factors should be complemented more widely by cardiac CT in the primary prevention of cardiovascular disease.
The International Journal of Cardiovascular Imaging, 2021
The purpose is to investigate the added prognostic value of coronary artery calcium (CAC), thoracic aortic calcium (TAC), and heart valve calcium scores for prediction of a combined endpoint of recurrent major cardiovascular events and cardiovascular interventions (MACE +) in patients with established cardiovascular disease (CVD). In total, 567 patients with established CVD enrolled in a substudy of the UCC-SMART cohort, entailing cardiovascular CT imaging and calcium scoring, were studied. Five Cox proportional hazards models for prediction of 4-year risk of MACE + were developed; traditional CVD risk predictors only (model I), with addition of CAC (model II), TAC (model III), heart valve calcium (model IV), and all calcium scores (model V). Bootstrapping was performed to account for optimism. During a median follow-up of 3.43 years (IQR 2.28–4.74) 77 events occurred (MACE+). Calibration of predicted versus observed 4-year risk for model I without calcium scores was good, and the c...
Clinical Evaluation and Calcium Score as Methods for Selecting Patients Eligible for CT Angiogram
2014
PURPOSE:Our aim was to compare the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). METHODS: We enrolled 60 patients (age 61.3 ± 10.4 years, 40 men) with angina and no history of CAD. All underwent ex-ECG and CTA and were followed for 12 months. The endpoints were cardiac events - nonfatal myocardial infarction, cardiac death, and revascularization. RESULTS: ex-ECG and CTA were positive in 36 (60%) and 24 (40%) of 60 patients, respectively. Both ex-ECG and CTA were predictors of cardiac events (hazard ratio [HR]: 2, p < 0.0001 and HR: 20, 95% p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% ,p = 0.02 and HR: 6.8; p < 0.0001, respectively), in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Ex-ECG provides a further risk stratification in the subset of patients wit...
BioMed Research International, 2013
This work aims to validate the clinical significance of coronary artery calcium score (CACS) in predicting coronary artery disease (CAD) and cardiac events in 100 symptomatic patients (aged 37-87 years, mean 62.5, 81 males) that were followed up for a mean of 5 years. Our results showed that patients with CAD and cardiac events had significantly higher CACS than those without CAD and cardiac events, respectively. The corresponding data were 1450.42 ± 3471.24 versus 130 ± 188.29 ( < 0.001) for CAD, and 1558.67 ± 513.29 versus 400.46 ± 104.47 ( = 0.031) for cardiac events. Of 72 patients with CAD, cardiac events were found in 56 (77.7%) patients. The prevalence of cardiac events in our cohort was 13.3% for calcium score 0, 50% for score 11-100, 56% for score 101-400, 68.7% for score 401-1,000, and 75.0% for score >1000. Increased CACS (>100) was also associated with an increased frequency of multi-vessel disease. Nonetheless, 3 (20%) out of 15 patients with zero CACS had single-vessel disease. Significant correlation ( < 0.001) was observed between CACS and CAD on a vessel-based analysis for coronary arteries. It is concluded that CACS is significantly correlated with CAD and cardiac events.