Prognostic Value of Coronary CT Angiography and Calcium Score for Major Adverse Cardiac Events in Outpatients
ABSTRACT This study sought to evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CTA) for major adverse cardiac events (MACE).
The prognostic value of CACS has been well described. Few studies use the rich information of coronary CTA to predict future clinical outcomes and compare CACS with coronary CTA.
We followed up 5,007 outpatients who were suspected of having coronary artery disease (CAD) and who underwent cardiac CTA. Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in coronary CTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization.
Follow-up was completed in 4,425 patients (88.4%), with a median follow-up period of 1,081 days. At the end of the follow-up period, 363 (8.2%) patients had experienced MACE. Cumulative probability of 3-year MACE increased across CT strata for CACS (CACS 0, 2.1%; CACS 1 to 100, 12.9%; CACS 101 to 400, 16.3%; and CACS >400, 33.8%; log-rank p < 0.001); for coronary CTA (no plaque 0.8%, nonobstructive disease 3.7%, 1-vessel disease 27.6%, 2-vessel disease 35.5%, and 3-vessel disease 57.7%; log-rank p < 0.001); and for characteristics of the plaques (5.5% for calcified plaque, 22.7% for noncalcified plaque, and 37.7% for mixed plaque; log-rank p < 0.001). The area under the receiver-operating characteristic curves showed the incremental value of CACS and coronary CTA for predicting MACE: 0.71 for clinical risk factors, which improved to 0.82 by adding CACS and further improved to 0.93 by adding coronary CTA (both p < 0.001).
The CACS and coronary CTA findings have prognostic value and have incremental value over routine risk factors for MACE, and coronary CTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value.
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ABSTRACT: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines are being applied to HIV-infected patients but have not been validated in this at-risk population, which is known to have a high prevalence of subclinical high-risk morphology (HRM) coronary atherosclerotic plaque.AIDS (London, England) 09/2014; 28(14):2061-2070. DOI:10.1097/QAD.0000000000000360 · 6.56 Impact Factor
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ABSTRACT: Coronary artery calcium (CAC) scanning is a reliable, noninvasive technique for estimating overall coronary plaque burden and for identifying risk for future cardiac events. Arthur Agatston and Warren Janowitz published the first technique for scoring CAC scans in 1990. Given the lack of available data correlating CAC with burden of coronary atherosclerosis at that time, their scoring algorithm was remarkable, by somewhat arbitrary. Since then, a few other scoring techniques have been proposed for the measurement of CAC including, the Volume score and Mass score. Yet despite new data, little in this field has changed in the last 15 years. The main focus of our paper is to review the implications of our approach to scoring CAC scans in terms of correlation with the central disease – coronary atherosclerosis. We first discuss the methodology of each available scoring system, describing how each of these scores make important indirect assumptions in the way they account (or do not account) for calcium density, location of calcium, spatial distribution of calcium, and microcalcification/emerging calcium that might limit their predictive power. These assumptions require further study in well-designed, large event-driven studies. In general, all of these scores are adequate and are highly correlated with each other. Despite its age, the Agatston score remains the most extensively studied and widely accepted technique in both the clinical and research settings. After discussing CAC scoring in the era of contrast enhanced coronary CT angiography, we discuss suggested potential modifications to current CAC scanning protocols with respect to tube voltage, tube current, and slice thickness which may further improve the value of CAC scoring. We close with a focused discussion of the most important future directions in the field of CAC scoring.Atherosclerosis 01/2015; DOI:10.1016/j.atherosclerosis.2014.12.040 · 3.71 Impact Factor
AIDS (London, England) 09/2014; 28(14):2153-2155. DOI:10.1097/QAD.0000000000000416 · 6.56 Impact Factor