Utilizing (serial) coronary computed tomography angiography (CCTA) to predict plaque progression and major adverse cardiac events (MACE): results, merits and challenges

2022 ◽  
Author(s):  
F. Y. van Driest ◽  
C. M. Bijns ◽  
R. J. van der Geest ◽  
A. Broersen ◽  
J. Dijkstra ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Major Adverse Cardiac Events ◽  
Plaque Progression ◽  
Cardiac Events ◽  
Coronary Computed Tomography ◽  
Adverse Cardiac Events

scholarly journals HEART score improves efficiency of coronary computed tomography angiography in patients suspected of acute coronary syndrome in the emergency department

2019 ◽  
Vol 9 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Murat Arslan ◽  
Jeroen Schaap ◽  
Pleunie PM Rood ◽  
Koen Nieman ◽  
Ricardo PJ Budde ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Coronary Computed Tomography ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events

Aims: Coronary computed tomography angiography is increasingly employed in the emergency department for suspected acute coronary syndrome patients. The HEART score has been proposed for initial risk stratification in these patients. The aim of this study was to investigate the diagnostic value and efficiency of the HEART score before coronary computed tomography angiography. Methods and results: We included patients suspected of acute coronary syndrome who underwent coronary computed tomography angiography in the emergency department. Based on the HEART score, patients were stratified as low-risk (HEART≤3), intermediate-risk (HEART4–6) and high-risk (HEART≥7). We assessed coronary computed tomography angiography for the presence of significant coronary artery disease (>50% stenosis). The primary outcome, the level of major adverse cardiac events, was a composite endpoint of all-cause mortality, acute coronary syndrome or coronary revascularisation within 30 days. The study population consisted of 340 patients (mean age: 55.6±10.1 years, 44.7% women), major adverse cardiac events occurred in 45 (13.2%) patients. The incidence of major adverse cardiac events in patients stratified as low-risk (35.0%), intermediate-risk (56.8%) and high-risk (8.2%) was 3.4%, 12.4% and 60.7%, respectively. All four low-risk patients with major adverse cardiac events had a HEART score of three. An algorithm where coronary computed tomography angiography is reserved for patients with HEART 3–6 resulted in a sensitivity of 97.8%, specificity of 84.1%, negative predictive value of 99.6% and positive predictive value of 48.4%, while reducing the need for coronary computed tomography angiography by 22% ( n=75). Conclusion: The predictive value of coronary computed tomography angiography for 30-day major adverse cardiac events in suspected acute coronary syndrome patients is good, and reserving coronary computed tomography angiography for HEART score 3–6 patients reduces the number of needed coronary computed tomography angiograms without affecting diagnostic accuracy.

scholarly journals Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease

2020 ◽  
Vol 9 (2) ◽  
pp. 604 ◽  
Author(s):  
Mark Rabbat ◽  
Jonathon Leipsic ◽  
Jeroen Bax ◽  
Brian Kauh ◽  
Rina Verma ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Invasive Coronary Angiography ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Coronary Computed Tomography ◽  
Flow Reserve ◽  
Adverse Cardiac Events

Objectives: In the United States, the real-world feasibility and outcome of using fractional flow reserve from coronary computed tomography angiography (FFRCT) is unknown. We sought to determine whether a strategy that combined coronary computed tomography angiography (CTA) and FFRCT could safely reduce the need for invasive coronary angiography (ICA), as compared to coronary CTA alone. Methods: The study included 387 consecutive patients with suspected CAD referred for coronary CTA with selective FFRCT and 44 control patients who underwent CTA alone. Lesions with 30–90% diameter stenoses were considered of indeterminate hemodynamic significance and underwent FFRCT. Nadir FFRCT ≤ 0.80 was positive. The rate of patients having ICA, revascularization and major adverse cardiac events were recorded. Results: Using coronary CTA and selective FFRCT, 121 patients (32%) had at least one vessel with ≥50% diameter stenosis; 67/121 (55%) patients had at least one vessel with FFRCT ≤ 0.80; 55/121 (45%) underwent ICA; and 34 were revascularized. The proportion of ICA patients undergoing revascularization was 62% (34 of 55). The number of patients with vessels with 30–50% diameter of stenosis was 90 (23%); 28/90 (31%) patients had at least one vessel with FFRCT ≤ 0.80; 8/90 (9%) underwent ICA; and five were revascularized. In our institutional practice, compared to coronary CTA alone, coronary CTA with selective FFRCT reduced the rates of ICA (45% vs. 80%) for those with obstructive CAD. Using coronary CTA with selective FFRCT, no major adverse cardiac events occurred over a mean follow-up of 440 days. Conclusion: FFRCT safely deferred ICA in patients with CAD of indeterminate hemodynamic significance. A high proportion of those who underwent ICA were revascularized.

scholarly journals Coronary computed tomography angiography derived risk score in predicting cardiac events

2017 ◽  
Vol 11 (4) ◽  
pp. 274-280 ◽  
Author(s):  
Valtteri Uusitalo ◽  
Vasileios Kamperidis ◽  
Michiel A. de Graaf ◽  
Teemu Maaniitty ◽  
Iida Stenström ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Risk Score ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Cardiac Events ◽  
Coronary Computed Tomography

scholarly journals Changes in Atherosclerotic Plaque Composition with Anti-Lipid Therapy as Detected by Coronary Computed Tomography Angiography

2021 ◽  
Author(s):  
Drew Thomas ◽  
Darma Marcelin ◽  
Shone Almeida
Keyword(s):  
Computed Tomography ◽  
Cardiovascular Disease ◽  
Atherosclerotic Plaque ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Plaque Composition ◽  
Cardiac Events ◽  
Mortality And Morbidity ◽  
Lipid Management ◽  
Coronary Computed Tomography

Lipid management remains the mainstay of cardiovascular disease prevention. Drugs that target cholesterol reduction, such as HMG-CoA reductase inhibitors (statins) and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, have shown significant mortality and morbidity benefit. Predominantly targeting low-density lipoprotein (LDL). These drugs have been indicated to reduce lipid composition and plaque proliferation. Total plaque burden and composition can now be assessed with noninvasive advanced cardiac imaging modalities. This chapter will address the components of atherosclerotic plaque as identified with coronary computed tomography angiography (CCTA) and review in detail the changes in plaque characteristics that may be responsible for reduction in cardiac events. These changes in plaque composition may help guide future management of cardiovascular disease, serving as an imaging biomarker for better risk stratification. Readers will gain a deeper understanding of plaque morphology with direct clinical applicability as well as an understanding of how noninvasive imaging can be utilized to assess plaque composition.

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