Prevalence of Severe Subclinical Coronary Artery Disease on Cardiac CT and MRI in Patients with Extra-cardiac Arterial Disease

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

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ABSENCE OF CORONARY ARTERY CALCIUM DOES NOT FULLY EXCLUDE OBSTRUCTIVE CORONARY ARTERY DISEASE AND FUTURE ADVERSE EVENTS AMONG PATIENTS REFERRED FOR CARDIAC CT ANGIOGRAPHY: RESULTS FROM 17,528 PATIENTS IN THE CONFIRM REGISTRY (CORONARY CT ANGIOGRAPHY EVALUATION FOR CLINICAL OUTCOMES: AN INTERNATIONAL MULTICENTER REGISTRY)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)62035-4 ◽

2011 ◽

Vol 57 (14) ◽

pp. E2035

Author(s):

Todd C. Villines ◽

Edward Hulten ◽

Alison Dunning ◽

Leslee J. Shaw ◽

Stephan Achenbach ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Cardiac Ct ◽

Obstructive Coronary Artery Disease ◽

Coronary Ct ◽

Artery Disease ◽

International Multicenter ◽

Multicenter Registry

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Burden Of Major Adverse Cardiac Events (Mace) In Patients With Coronary Artery Disease (Cad) Or Peripheral Arterial Disease (Pad)

Value in Health ◽

10.1016/j.jval.2014.03.622 ◽

2014 ◽

Vol 17 (3) ◽

pp. A106

Author(s):

H. Khoury ◽

L. Lavoie ◽

S. Welner ◽

K. Folkerts

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Artery Disease ◽

Peripheral Arterial

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Coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD): diagnostic impact and clinical consequences in the German Cardiac CT Registry depending on stress test results

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-018-1504-0 ◽

2018 ◽

Vol 35 (4) ◽

pp. 741-748 ◽

Cited By ~ 1

Author(s):

Sebastian Barth ◽

Mohamed Marwan ◽

Jörg Hausleiter ◽

Werner Moshage ◽

Grigorios Korosoglou ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Ct ◽

Coronary Computed Tomography Angiography ◽

Stress Test ◽

Stable Coronary Artery Disease ◽

Test Results ◽

Clinical Consequences ◽

Artery Disease

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Correlation between Peripheral Arterial Disease and Coronary Artery Disease in Bangladeshi Population- A Five Years Retrospective Study

University Heart Journal ◽

10.3329/uhj.v11i2.31370 ◽

2017 ◽

Vol 11 (2) ◽

pp. 79-84

Author(s):

Syed Dawood Md Taimur ◽

Mashhud Zia Chowdhury ◽

Md Enamul Hakim

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Arterial Disease ◽

Positive Family History ◽

Arterial Disease ◽

Coronary Angiogram ◽

Vessel Disease ◽

Artery Disease ◽

Peripheral Arterial

Background: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown.Objective: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiogram and to determine the relationship between presence of PAD and severity of CAD. Material &Methods: This five years retrospective study was conducted at invasive lab of the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from January 2010 to December 2014. Total 77 patients were included in this study. Study variables were age, sex, risk factors like hypertension, diabetes mellitus, dyslipidaemia, smoking habit and positive family history for ischemic heart disease, severity of coronary artery and peripheral artery disease.Results: Mean age was 56.83±13.64 years, Male mean age was 53.98±15.08 years and female mean age was 54.5±1.73years. Hypertension were detected in 55.8%, diabetes in 87%, dyslipidaemia in 81.8%, smoking habits in 88.3% and 58.4% had positive family history. After catheterization 88.3% had peripheral arterial disease and 71.4% had coronary artery disease. Out of 77 patients 52 had both coronary and peripheral arterial disease which was statistically significant (p<.014). Coronary angiogram revealed 28.6% (22) patients had triple vessel disease, 23.3% (18) had single vessel disease, 19.5% (15) had double vessel disease and 28.6% (22) were normal coronary arteries. Peripheral angiogram revealed 51.9% had superficial femoral artery disease, 24.7% had anterior tibial artery disease, 26% had posterior tibial artery disease, 15.6% had common iliac artery and common femoral artery disease and 2.6% had renal artery disease.Conclusion: There is a strong and definite correlation between coronary and peripheral arterial disease. We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD.University Heart Journal Vol. 11, No. 2, July 2015; 79-84

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Long-term outcomes of peripheral arterial disease patients with significant coronary artery disease undergoing percutaneous coronary intervention

PLoS ONE ◽

10.1371/journal.pone.0251542 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251542

Author(s):

Byoung Geol Choi ◽

Ji-Yeon Hong ◽

Seung-Woon Rha ◽

Cheol Ung Choi ◽

Michael S. Lee

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Arterial Disease ◽

Significant Coronary Artery Disease ◽

Arterial Disease ◽

Term Survival ◽

Artery Disease ◽

Peripheral Arterial

Background Patients with peripheral arterial disease (PAD) have known to a high risk of cardiac mortality. However, the effectiveness of the routine evaluation of coronary arteries such as routine coronary angiography (CAG) in PAD patients receiving percutaneous transluminal angioplasty (PTA) is unclear. Methods A total of 765 consecutive PAD patients underwent successful PTA and 674 patients (88.1%) underwent routine CAG. Coronary artery disease (CAD) was defined as angiographic stenosis ≥70%. Patients were divided into three groups; 1) routine CAG and a presence of CAD (n = 413 patients), 2) routine CAG and no CAD group (n = 261 patients), and 3) no CAG group (n = 91 patients). To adjust for any potential confounders that could cause bias, multivariable Cox-proportional hazards regression and propensity score matching (PSM) analysis was performed. Clinical outcomes were evaluated by Kaplan-Meier curved analysis at 5-year follow-up. Results In this study, the 5-year survival rate of patients with PAD who underwent PTA was 88.5%. Survival rates were similar among the CAD group, the no CAD group, and the no CAG group, respectively (87.7% vs. 90.4% vs. 86.8% P = 0.241). After PSM analysis between the CAD group and the no CAD group, during the 5-year clinical follow-up, there were no differences in the incidence of death, myocardial infarction, strokes, peripheral revascularization, or target extremity surgeries between the two groups except for repeat PCI, which was higher in the CAD group than the non-CAD group (9.3% vs. 0.8%, P<0.001). Conclusion PAD patients with CAD were expected to have very poor long-term survival, but they are shown no different long-term prognosis such as mortality compared to PAD patients without CAD. These PAD patients with CAD had received PCI and/or optimal medication treatment after the CAG. Therefore a strategy of routine CAG and subsequent PCI, if required, appears to be a reasonable strategy for mortality risk reduction of PAD patients. Our results highlight the importance for evaluation for CAD in patients with PAD.

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