LONG-TERM PROGNOSTIC VALUE OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY FINDINGS FOR ASYMPTOMATIC INDIVIDUALS: A 6-YEAR FOLLOW-UP OF 1,226 ASYMPTOMATIC INDIVIDUALS FROM THE PROSPECTIVE MULTICENTER INTERNATIONAL CONFIRM STUDY

Introduction: Coronary computed tomographic angiography (CCTA) is widely utilized for the detection of coronary artery disease (CAD). Foremost, the very low risk associated with normal CCTA is an important component for the purpose of cardiovascular risk stratification. To date, however, data that accounts for long-term prognosis of normal CCTA is sparse. Purpose: Using data from a multi-center, global observational CCTA registry, we sought to determine the potential warranty period of normal CCTA. Methods: Among 12,086 patients who underwent CCTA, 7,651 patients without history of previous CAD, aged between 30-74 years, were included in the current analysis and followed consecutively over 5 years. Normal CCTA was defined as the absence of any plaque in the coronary arteries. Annual mortality was calculated and compared with overall patients. The primary event in this study was all-cause mortality (ACM). Results: During a median follow-up of 5.8 years (IQR, 5.3-6.3 years), 120 of all-cause deaths occurred among 3,051 patients with normal CAD. Mean age of the study population was 52±11 years, and 45% were men. Annual mortality rate was 0.68% (95% confidence interval (CI), 0.57~0.82), while annual mortality of overall patients was 1.31% (95% CI, 1.20~1.42) ( p <0.001). When we defined warranty period as a follow-up duration until the estimated mortality reached the threshold of 5% using a Kaplan Meier curve, the warranty period of normal CCTA for ACM was 7.2 years. In subgroup analysis, according to a baseline risk factor profile using Framingham risk scores (FRS), annual mortality rate was 1.31% (95% CI, 0.85~2.03) among patients with high FRS and 0.62% (95% CI, 0.51~0.76) among those with low to intermediate FRS. Conclusion: Absence of CAD by CCTA demonstrates a favorable survival rate with a minimum warranty period of at least 7 years. Persons presenting with a high cardiovascular risk profile displayed a relatively higher mortality, which is similar to overall population. Therefore, they should be considered a distinct group of individuals at-risk by physicians and researchers alike.

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Faculty Opinions recommendation of Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718259302.793510534 ◽

2015 ◽

Author(s):

Nathan Wong

Keyword(s):

Prognostic Value ◽

Coronary Artery Calcium Score ◽

Calcium Score ◽

Computed Tomographic Angiography ◽

Cardiac Events ◽

Coronary Computed Tomographic Angiography ◽

Computed Tomographic ◽

Adverse Cardiac Events ◽

Tomographic Angiography ◽

Incremental Prognostic Value

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Practice Pattern, Diagnostic Yield, and Long‐Term Prognostic Impact of Coronary Computed Tomographic Angiography

Journal of the American Heart Association ◽

10.1161/jaha.120.016620 ◽

2020 ◽

Vol 9 (18) ◽

Author(s):

Min Soo Cho ◽

Jae‐Hyung Roh ◽

Hanbit Park ◽

Sang‐Cheol Cho ◽

Do‐Yoon Kang ◽

...

Keyword(s):

Myocardial Infarction ◽

Diagnostic Yield ◽

Computed Tomographic Angiography ◽

Therapeutic Interventions ◽

Coronary Cta ◽

Coronary Computed Tomographic Angiography ◽

Computed Tomographic ◽

Asymptomatic Patients ◽

Tomographic Angiography

Background Although guidelines recommend the use of coronary computed tomographic angiography (CTA) in patients with stable pain syndromes, the clinical benefits of the use of coronary CTA in a broad spectrum of patients is unknown. We evaluated the contemporary practice pattern and diagnostic yield of coronary CTA and their impact on the subsequent diagnostic‐therapeutic cascade and clinical outcomes. Methods and Results We identified 39 906 patients without known coronary artery disease (CAD) who underwent coronary CTA between January 2007 and December 2013. The patients' demographic characteristics, risk factors, symptoms, results of coronary CTA, the appropriateness of downstream diagnostic and therapeutic interventions, and long‐term outcomes (death or myocardial infarction) were evaluated. The number of coronary CTAs had increased over time, especially in asymptomatic patients. Coronary CTA revealed that 6108 patients (15.3%) had obstructive CAD (23.7% of symptomatic and 9.3% of asymptomatic patients). Subsequent cardiac catheterization was performed in 19.2% of symptomatic patients (appropriate, 80.6%) and in 3.9% of asymptomatic patients (appropriate, 7.9%). The 5‐year rate of death or myocardial infarction was significantly higher in patients with obstructive CAD on CTA than those without (7.2% versus 3.0%; P <0.001; adjusted hazard ratio [95% CI], 1.34 [1.17–1.54]). However, obstructive CAD on CTA had limited added value over conventional risk factors for predicting death or myocardial infarction. Conclusions Although the use of coronary CTA had substantially increased, CTA had a low diagnostic yield for obstructive CAD, especially in asymptomatic patients. The use of CTA in asymptomatic patients seemed to have led to inappropriate subsequent diagnostic or therapeutic interventions without clinical benefit.

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P6149Coronary computed tomographic angiography (CTA) for risk stratification in the diagnostic triage of patients undergoing liver transplantation (LT): A long-term outcome study

European Heart Journal ◽

10.1093/eurheartj/ehz746.0755 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Strobl ◽

T Senoner ◽

A Finkenstedt ◽

G Widmann ◽

F Plank ◽

...

Keyword(s):

Risk Stratification ◽

Calcium Score ◽

Computed Tomographic Angiography ◽

Plaque Burden ◽

Computed Tomographic ◽

All Cause Mortality ◽

Stenosis Severity ◽

Tomographic Angiography

Abstract Background Cardiovascular (CV) risk stratification in patients with end-stage liver disease (ESLD) prior to liver transplantation (LT) is crucial: CV-disease poses a major threat for posttransplant survival. Therefore, our purpose was to assess safety of coronary computed tomographic angiography (CTA) in patients prior to orthotopic LT over a long-term follow up period, and its value for CV risk stratification. Methods In this single center, retrospective observational study 458 patients underwent coronary calcium score (CCS) and coronary CTA for pre-LT risk stratification between 2005 and 2016. CTA was evaluated for 1) stenosis severity (CADRADS: 4-severe>70%/3-intermediate50–70%/2-mild<50%/1-minimal<25%/0=no CAD) 2) plaque burden (SIS, G-score), 3) high–risk plaque features (Napkin Ring Sign, low attenuation plaque, positive remodelling) and 4) Coronary Calcium Score. Primary endpoint was mortality (all-cause and cardiovascular), secondary endpoint major cardiovascular events (MACE). Results Finally 270 patients (79.3% males, age 61±8.5 years) who underwent orthotopic LT were included (mean follow-up 7.5 years±3.1, range 2–13). 87 (32.2%) had CCS zero and 60 (22.2%) CCS >300 Agatston Units (CCS 335.6 AU± 868.9). 248 patients underwent CTA after CCS. The majority had CAD (n=173, 72.3%) by CTA while only 75 (27.7%) had no CAD. 102 patients (38.8%) had minimal-or-mild stenosis<50% (CADRADS 1–2), 34 (12.9%) intermediate and 17 (6.5%) severe stenosis.Out of CCS 0 patients, 13 had non-calcified plaque. All-cause mortality rate was 46 (17.0%), with the majority of patients (43 (93.5%) experiencing non-cardiac death and 3 (6.5%) cardiovascular death due to 1 myocardial infarction and 2 cardiopulmonary failure. CADRADS predicted mortality (Kaplan Meir, p<0.001). On multivariate Cox Regression modell, SIS and G-score predicted all-cause mortality (HR 1.1:p=0.034; 95% CI: 0.649–0.983 and HR 1.1, p=0.029; 95% CI: 1.0–1.6), while Calcium Score did not. There were 6 MACE (3 STEMI, 3 NSTEMI). MACE rate was 0% in CADRADS 0 or 1, 1 in CADRADS-2 and increasing to 5 in CADRADS 3 and 4 groups. Coronary CTA for LT risk stratification Conclusion Cardiac CT is a reliable non-invasive modality for pre-LT assessment of CV-risk over a long-term period, with 0% MACE in patients with no CAD or minimal CAD. CTA allows for an improved CV-risk stratification by stenosis severity (CADRADS) and plaque burden as compared to calcium scoring.

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