Prognostic Value of Coronary CT Angiography and Calcium Score for Major Adverse Cardiac Events in Outpatients

Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
JACC. Cardiovascular imaging (Impact Factor: 7.19). 10/2012; 5(10):990-9. DOI: 10.1016/j.jcmg.2012.06.006
Source: PubMed


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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    • "The prognostic impact of coronary atherosclerotic burden defined as CACS for symptomatic patients has been also reported. In the study examining the relation of CACS and CCTA findings to MACE including cardiac death, nonfatal myocardial infarction, or coronary revascularization among 4425 symptomatic subjects reported by Hou and colleagues, the combined CACS and CCTA findings with stenosis severity provided the incremental prognostic information in predicting MACE over the combination of risk factors and CACS or the risk factors alone (AUC: 0.92 versus 0.82 versus 0.68) [65]. "
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    ABSTRACT: For a decade, coronary computed tomographic angiography (CCTA) has been used as a promising noninvasive modality for the assessment of coronary artery disease (CAD) as well as cardiovascular risks. CCTA can provide more information incorporating the presence, extent, and severity of CAD; coronary plaque burden; and characteristics that highly correlate with those on invasive coronary angiography. Moreover, recent techniques of CCTA allow assessing hemodynamic significance of CAD. CCTA may be potentially used as a substitute for other invasive or noninvasive modalities. This review summarizes risk stratification by anatomical and hemodynamic information of CAD, coronary plaque characteristics, and burden observed on CCTA.
    Full-text · Article · Sep 2014
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    • "In symptomatic patients, the CAC score was associated with a composite of cardiac death, non-fatal MI and coronary revascularization, although calcified plaques had the lowest predictive value compared to non-calcified and mixed plaque [14]. A similar composite outcome was predicted among type 2 diabetics [15] and heavy smokers [7] but the CAC score did not predict ACS development in chest pain patients [16]. "
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    ABSTRACT: A review of the predictive ability of arterial and valvular calcification has shown an additive effect of calcification in more than 1 location in predicting mortality and coronary heart disease, with mitral annual calcification being a particularly strong predictor. In individual arteries and valves there is a clear association between calcification presence, extent and progression and future cardiovascular events and mortality in asymptomatic, symptomatic and high risk patients, although adjustment for calcification in other arterial beds generally renders associations non-significant. Furthermore, in acute coronary syndrome, culprit plaque is normally not calcified. This would tend to reduce the validity of calcification as a predictor and suggest that the association with cardiovascular events and mortality may not be causal. The association with stroke is less clear; carotid and intracranial artery calcification show little predictive ability, with symptomatic plaques tending to be uncalcified.
    Full-text · Article · Jun 2014 · IJC Heart and Vessels
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    • "As an important part of vascular calcification, coronary artery calcification (CAC) can be rapidly and noninvasively quantitatively determined by computed tomography (CT). It may reflect the overall load of coronary atherosclerosis plaque and major adverse cardiac events in outpatients [9]. Many clinical studies have shown that high amounts of CAC can predict an increased risk of myocardial infarction and sudden coronary death [10-13]. "
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    ABSTRACT: Hypoxia-inducible factor 1 (HIF-1), a master regulator of oxygen homeostasis, is a heterodimer consisting of HIF-1alpha and HIF-1beta subunits, and is implicated in calcification of cartilage and vasculature. The goal of this study was to determine the relationship between serum HIF-1alpha with coronary artery calcification (CAC) in patients with type 2 diabetes. The subjects were 405 (262 males, 143 females, age 51.3 +/- 6.4 years) asymptomatic patients with type 2 diabetes mellitus. Serum HIF-1alpha and interleukin-6 (IL-6) levels were measured by ELISA. CAC scores were assessed by a 320-slice CT scanner. The subjects were divided into 4 quartiles depending on serum HIF-1alpha levels. Average serum HIF-1alpha was 184.4 +/- 66.7 pg/ml. Among patients with higher CAC scores, HIF-1alpha levels were also significantly increased (p <0.001). HIF-1alpha levels positively correlated with CRP, IL-6, UKPDS risk score, HbA1c, FBG, and CACS, but did not correlate with diabetes duration, age, and LDL. According to the multivariate analysis, HIF-1alpha levels significantly and independently predict the presence of CAC. ROC curve analysis showed that the serum HIF-1alpha level can predict the extent of CAC, but the specificity was lower than the traditional risk factors UKPDS and HbA1c. As a marker of hypoxia, serum HIF-1alpha level may be an independent risk factor for the presence of CAC. These findings indicate that elevated serum HIF-1alpha may be involved in vascular calcification in patients with type 2 diabetes mellitus.
    Full-text · Article · Feb 2014 · Cardiovascular Diabetology
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