Prognostic Value of CAD-RADS Classification by Coronary CTA in Patients With Suspected CAD

Abstract Background: The study sought to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) classification with traditional coronary artery disease (CAD) classifications and Duke Prognostic CAD Index for predicting the risk of all-cause mortality in patients with suspected CAD.Methods: 9625 consecutive suspected CAD patients were assessed by coronary CTA for CAD-RADS classification, traditional CAD classifications and Duke Prognostic CAD Index. Kaplan-Meier and multivariable Cox models were used to estimate all-cause mortality. Discriminatory ability of classifications was assessed using receiver-operating characteristic (ROC) curves and the Hosmer-Lemeshow goodness-of-fit test.Results: A total of 540 patients died from all causes with a median follow-up of 4.3 ±2.1 years. Kaplan-Meier survival curves showed the cumulative events increased significantly associated with CAD-RADS, three traditional CAD classifications and Duke Prognostic CAD Index. In multivariate Cox regressions, the risk for the all-cause death increased from HR 0.861 (95% CI: 0.420 to 1.764) for CAD-RADS 1 to HR 2.761 (95% CI: 1.961 to 3.887) for CAD-RADS 4B&5, using CAD-RADS 0 as the reference group. The relative HR s for all-cause death increased proportionally with the grades of the three traditional CAD classifications and Duke Prognostic CAD Index. The ROC curve for prediction of all cause death was 0.7927 for CAD-RADS, which was non-inferior to the traditional CAD classifications and Duke Prognostic CAD Index.Conclusions: CAD-RADS classification provided important prognostic information for patients with suspected CAD with noninvasive evaluation, which was non-inferior than Duke Prognostic CAD Index and traditional stenosis-based grading schemes.

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Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02286-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zengfa Huang ◽

Shutong Zhang ◽

Nan Jin ◽

Yun Hu ◽

Jianwei Xiao ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Prognostic Value ◽

Goodness Of Fit ◽

Time Dependent ◽

Goodness Of Fit Test ◽

Coronary Cta ◽

Kaplan Meier ◽

All Cause Mortality ◽

Artery Disease

Abstract Background The study sought to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) classification with traditional coronary artery disease (CAD) classifications and Duke Prognostic CAD Index for predicting the risk of all-cause mortality in patients with suspected CAD. Methods 9625 consecutive suspected CAD patients were assessed by coronary CTA for CAD-RADS classification, traditional CAD classifications and Duke Prognostic CAD Index. Kaplan–Meier and multivariable Cox models were used to estimate all-cause mortality. Discriminatory ability of classifications was assessed using time dependent receiver-operating characteristic (ROC) curves and The Hosmer–Lemeshow goodness-of-fit test was employed to evaluate calibration. Results A total of 540 patients died from all causes with a median follow-up of 4.3 ± 2.1 years. Kaplan–Meier survival curves showed the cumulative events increased significantly associated with CAD-RADS, three traditional CAD classifications and Duke Prognostic CAD Index. In multivariate Cox regressions, the risk for the all-cause death increased from HR 0.861 (95% CI 0.420–1.764) for CAD-RADS 1 to HR 2.761 (95% CI 1.961–3.887) for CAD-RADS 4B&5, using CAD-RADS 0 as the reference group. The relative HRs for all-cause death increased proportionally with the grades of the three traditional CAD classifications and Duke Prognostic CAD Index. The area under the time dependent ROC curve for prediction of all-cause death was 0.7917, 0.7805, 0.7991for CAD-RADS in 1 year, 3 year, 5 year, respectively, which was non-inferior to the traditional CAD classifications and Duke Prognostic CAD Index. Conclusions The CAD-RADS classification provided important prognostic information for patients with suspected CAD with noninvasive evaluation, which was non-inferior than Duke Prognostic CAD Index and traditional stenosis-based grading schemes in prognostic value of all-cause mortality. Traditional and simplest CAD classification should be preferable, given the more number of groups and complexity of CAD-RADS and Duke prognostic index, without using more time consuming classification.

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Prognostic value of fat attenuation index of pericoronary adipose tissue surrounding left anterior descending artery on coronary computed tomography angiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.1346 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Sugiyama ◽

Y Kanaji ◽

M Hoshino ◽

M Yamaguchi ◽

M Hada ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Adipose Tissue ◽

Coronary Artery ◽

Prognostic Value ◽

Coronary Computed Tomography Angiography ◽

Coronary Cta ◽

Kaplan Meier ◽

Attenuation Index ◽

Artery Disease

Abstract Background Recent studies reported the association between elevated fat attenuation index (FAI) of pericoronary adipose tissue (PCAT) on coronary computed tomography angiography (CTA) and worse cardiac outcomes. Purpose We investigated the prognostic value of increased FAI-defined coronary inflammation status in patients with coronary artery disease. Methods Three-hundred fifty-eight patients (127 acute coronary syndromes [ACS], 231 stable coronary artery disease) with left anterior descending artery (LAD) as a culprit vessel who underwent coronary CTA were retrospectively studied. The FAI defined as the mean CT attenuation value of PCAT (−190 to −30 Hounsfield Unit [HU]) was measured at the proximal 40-mm segment of LAD. All subjects were divided into two groups according to the median value of FAI in the LAD. The association between the incidence of major adverse cardiac events (MACE) including all-cause death, myocardial infarction, heart failure, target and non-target vessel revascularization were evaluated. Results In a total of 358 patients, median FAI values surrounding the LAD was −71.46 (interquartile range, −77.10 to −66.34) HU. Thirty-eight patients (10.6%) experienced MACE during the follow-up period (median, 818 days). Kaplan-Meier analysis revealed that high FAI-LAD (>−71.46 HU [median]) was significantly associated with the incidence of MACE (log-rank test, chi-square = 4.183, P=0.041) (Figure). Conclusions In patients with coronary artery disease with culprit LAD lesions, elevated FAI of PCAT surrounding the LAD was associated with worse clinical outcomes. Assessment of FAI may have a potential for potential for non-invasive risk-stratification by coronary CTA. Kaplan-Meier analysis for MACE Funding Acknowledgement Type of funding source: None

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Association between baseline ldl-c and prognosis among patients with coronary artery disease and advanced kidney disease

European Heart Journal ◽

10.1093/eurheartj/ehab724.2909 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

B Wang ◽

J Liu ◽

S Q Chen ◽

Q H Luo ◽

Y Liu ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Kidney Disease ◽

Cox Regression ◽

Cardiovascular Research ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality ◽

Artery Disease ◽

Worse Prognosis

Abstract Background Lower low-density lipoprotein cholesterol (LDL-C) is significantly associated with improved prognosis in patients with coronary artery disease (CAD). However, LDL-C reduction does not decrease all-cause mortality among CAD patients when renal function impairs. There are currently no studies examining the association of low baseline LDL-C concentration (<1.8 mmol/L) with mortality among patients with CAD and advanced kidney disease (AKD). We aimed to evaluate prognostic value of low baseline LDL-C level for all-cause death in these patients. Methods In this observational study, 803 CAD patients complicated with AKD (eGFR <30 mL/min/1.73 m 2) were enrolled between January 2008 to December 2018. Patients were divided into two groups (LDL-C <1.8 mmol/L, n=138; LDL-C ≥1.8 mmol/L, n=665). We used Kaplan-Meier methods and Cox regression analyses to assess the association between baseline low LDL-C levels and long-term all-cause mortality. Results Among 803 participants (mean age 67.4 years; 68.5% male), there were 315 incidents of all-cause death during a median follow-up of 2.7 years. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for full 24 confounders (e.g., age, diabetes, heart failure, and dialysis, etc.), multivariate Cox regression analysis revealed that lower LDL-C level (<1.8mmol/L) was significantly associated with higher risk of all-cause death (adjusted HR, 1.38; 95% CI, 1.01–1.89). Conclusions Our data demonstrated that among patients with CAD and AKD, a lower baseline LDLC level (<1.8mmol/L) did not present a higher survival rate but was related to a worse prognosis, suggesting a cautiousness of too low LDL-C levels among patients with CAD and AKD. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This study was supported by the National Natural Science Foundation of China (Grant No. 81670339 and Grant No. 81970311), Cardiovascular Research Foundation Project of the Chinese Medical Doctor Association (SCRFCMDA201216) and Beijing Lisheng Cardiovascular Health Foundation (LHJJ20141751).

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Platelet-to-hemoglobin ratio as a valuable predictor of long-term all-cause mortality in coronary artery disease patients with congestive heart failure

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02423-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kunming Bao ◽

Haozhang Huang ◽

Guoyong Huang ◽

Junjie Wang ◽

Ying Liao ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Congestive Heart Failure ◽

Coronary Artery ◽

Prognostic Biomarker ◽

Kaplan Meier ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease

Abstract Background The platelet-to-hemoglobin ratio (PHR) has emerged as a prognostic biomarker in coronary artery disease (CAD) patients after PCI but not clear in CAD complicated with congestive heart failure (CHF). Hence, we aimed to assess the association between PHR and long-term all-cause mortality among CAD patients with CHF. Methods Based on the registry at Guangdong Provincial People’s Hospital in China, we analyzed data of 2599 hospitalized patients who underwent coronary angiography (CAG) and were diagnosed with CAD complicated by CHF from January 2007 to December 2018. Low PHR was defined as ˂ 1.69 (group 1) and high PHR as ≥ 1.69 (group 2). Prognosis analysis was performed using Kaplan–Meier method. To assess the association between PHR and long-term all-cause mortality, a Cox-regression model was fitted. Results During a median follow-up of 5.2 (3.1–7.8) years, a total of 985 (37.9%) patients died. On the Kaplan–Meier analysis, patients in high PHR group had a worse prognosis than those in low PHR group (log-rank, p = 0.0011). After adjustment for confounders, high PHR was correlated with an increased risk of long-term all-cause mortality in CAD patients complicated with CHF. (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 1.13–1.52, p < 0.0001). Conclusion Elevated PHR is correlated with an increased risk of long-term all-cause mortality in CAD patients with CHF. These results indicate that PHR may be a useful prognostic biomarker for this population. Meanwhile, it is necessary to take effective preventive measures to regulate both hemoglobin levels and platelet counts in this population.

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Predictive Value of the Triglyceride to High-Density Lipoprotein Cholesterol Ratio for All-Cause Mortality and Cardiovascular Death in Diabetic Patients With Coronary Artery Disease Treated With Statins

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.718604 ◽

2021 ◽

Vol 8 ◽

Author(s):

Le Wang ◽

Hongliang Cong ◽

Jingxia Zhang ◽

Yuecheng Hu ◽

Ao Wei ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Density Lipoprotein ◽

Cardiovascular Death ◽

Diabetic Patients ◽

C Statistic ◽

Kaplan Meier ◽

All Cause Mortality ◽

Artery Disease

Background and Aims: Studies have highlighted the role of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio on subsequent cardiovascular events. However, the association of the TG/HDL-C ratio with survival outcomes in diabetic patients with coronary artery disease (CAD) treated with statins remains unknown. This study aimed to assess the predictive value of the TG/HDL-C ratio for all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins.Methods: The data of patients with type 2 diabetes and angiographically-confirmed CAD who were undergoing statin therapy and visited Tianjin Chest Hospital between January 2016 and September 2016 were retrospectively collected. The patients were categorized based on the baseline TG/HDL-C ratio tertile. Kaplan-Meier analysis and multivariate Cox proportional hazard regression were applied to assess the role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death.Results: A total of 2,080 patients were included. During the 4-year follow-up, 209 patients died, 136 of whom from cardiovascular death. The Kaplan-Meier analyses showed that an increased TG/HDL-C ratio was associated with an increased risk of all-cause mortality (P < 0.001) and cardiovascular death (P < 0.001). The multivariate cox hazard regression analysis revealed a similar effect of the TG/HDL-C ratio on the risk of all-cause mortality (P = 0.046) and cardiovascular death (P = 0.009). The role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death was similar among all subgroups (P > 0.050). For all-cause mortality, the TG/HDL-C ratio significantly improved the C-statistic from 0.799 to 0.812 (P = 0.018), and the net reclassification index (NRI) and integrated discrimination index (IDI) were 0.252 (95% CI: 0.112–0.392; P < 0.001) and 0.012 (95% CI: 0.003–0.022; P = 0.012), respectively. Similarly, for cardiovascular death, the TG/HDL-C ratio significantly improved the C-statistic from 0.771 to 0.804 (P < 0.001), and the NRI and IDI were 0.508 (95% CI: 0.335–0.680; P < 0.001) and 0.033 (95% CI: 0.015–0.050; P < 0.001).Conclusion: TG/HDL-C ratio might be useful for predicting all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins.

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Platelet-to-hemoglobin ratio as a valuable predictor of long-term all-Cause mortality in coronary artery disease patients with congestive heart failure

10.21203/rs.3.rs-668943/v1 ◽

2021 ◽

Author(s):

Kunming Bao ◽

Haozhang Huang ◽

Guoyong Huang ◽

Junjie Wang ◽

Ying Liao ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Congestive Heart Failure ◽

Coronary Artery ◽

Prognostic Biomarker ◽

Kaplan Meier ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease

Abstract Background The platelet-to-hemoglobin ratio (PHR) has emerged as a prognostic biomarker in coronary artery disease (CAD) patients after PCI but not clear in CAD complicated with congestive heart failure (CHF). Hence, we aimed to assess the association between PHR and long-term all-cause mortality among CAD patients with CHF. Methods Based on the registry at Guangdong Provincial People’s Hospital in China, we analyzed data of 2,599 hospitalized patients who underwent coronary angiography (CAG) and were diagnosed with CAD complicated by CHF from January 2007 to December 2018. Low PHR was defined as˂1.69 (group 1) and high PHR as ≥ 1.69 (group 2). Prognosis analysis was performed using Kaplan-Meier methods. To assess the association between PHR and long-term all-cause mortality, a Cox-regression model was fitted. Results During a median follow-up of 5.2 (3.1–7.8) years, a total of 985 (37.9%) patients died. On the Kaplan-Meier analysis, patients in high PHR group had a worse prognosis than low PHR group (log-rank, p = 0.0011). After adjustment for confounders, high PHR was correlated with an increased risk of long-term all-cause mortality in CAD patients complicated with CHF. (adjusted hazard ratio [aHR], 1.21; 95% confidence interval [CI], 1.03–1.41, p = 0.02). Conclusion Elevated PHR is correlated with an increased risk of long-term all-cause mortality in CAD patients with CHF. These results indicate that PHR may be a useful prognostic biomarker for this population. Meanwhile, it is necessary to take effective preventive measures to regulate both hemoglobin levels and platelet counts in this population.

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Paradoxical Association Between Apolipoprotein B and Prognosis in Coronary Artery Disease: A 36,468 Chinese Cohort Study

10.21203/rs.3.rs-966786/v1 ◽

2021 ◽

Author(s):

Huanqiang Li ◽

Bo Wang ◽

Ziling Mai ◽

Sijia Yu ◽

Ziyou Zhou ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Apolipoprotein B ◽

Cox Regression ◽

Regression Analyses ◽

High Concentration ◽

Kaplan Meier ◽

All Cause Mortality ◽

Artery Disease

Abstract Background Apolipoprotein B (ApoB) and low-density lipoprotein cholesterol (LDL-C) was identified as the target for blood lipid management among coronary artery disease (CAD) patients. Previous studies reported an inverse correlation between baseline LDL-C concentration and clinical outcomes. However, the association between baseline ApoB concentration and long-term prognosis is unknown. Methods 36,486 CAD patients admitted to Guangdong Provincial People's Hospital in China were enrolled in this study and patients were categorized into two groups: high concentration of ApoB (≥65 mg/dL) group and low concentration of ApoB (< 65 mg/dL) group. The association between ApoB levels and long-term all-cause mortality was evaluated by the Kaplan-Meier method and Cox regression analyses. Results The overall mortality was 12.49% (n = 4,554) over a median follow-up period of 5.01 years. According to Kaplan–Meier analysis, patients with low baseline ApoB levels were paradoxically more likely to get a worse prognosis. Multivariate Cox regression analyses were performed to adjust for confounding factors such as age, gender, and comorbidity, and there was no obvious difference in long-term all-cause mortality among ApoB patients (aHR: 1.07, 95% CI: 0.99-1.16). When CONUT and total bilirubin were adjusted, the risk of long-term all-cause mortality would reduce in the low-ApoB (< 65mg/dl) group (aHR: 0.86, 95% CI: 0.78-0.96). In the fully covariable-adjusted model, patients in the ApoB < 65mg/d group had a 10.00% lower risk of long-term all-cause death when comparing to patients with ApoB≥65mg/dL (aHR: 0.90; 95% CI:0.81-0.99). Conclusion This study found a paradoxical association between baseline ApoB concentration and long-term all-cause mortality. Malnutrition and bilirubin mainly mediate the ApoB paradox.

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Stress-induced Myocardial Ischaemia – Perfusion Contrast Echocardiography to Evaluate Presence and Severity of Coronary Artery Disease

European Cardiology Review ◽

10.15420/ecr.2011.7.3.172 ◽

2011 ◽

Vol 7 (3) ◽

pp. 172

Author(s):

Benoy Nalin Shah ◽

Roxy Senior ◽

◽

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Perfusion ◽

Contrast Echocardiography ◽

Evidence Base ◽

Suspected Coronary Artery Disease ◽

Ultrasound Contrast Agents ◽

Prognostic Information ◽

Non Invasive ◽

Artery Disease

The development of stable transpulmonary ultrasound contrast agents (UCAs) has allowed the echocardiographic assessment of myocardial perfusion, a technique known as myocardial contrast echocardiography (MCE). MCE exploits the ultrasonic properties of UCAs, which consist of acoustically active gas-filled microspheres. These are intravascular agents that have a rheology similar to red blood cells and thus allow analysis of myocardial blood flow both at rest and after stress. The combined assessment of wall motion and myocardial perfusion provides significant diagnostic and prognostic information during stress echocardiography. Functional imaging tests, such as myocardial perfusion scintigraphy and stress cardiac magnetic resonance imaging, are also used for non-invasive assessment of coronary disease. The principal advantages of MCE are that it does not expose the patient to ionising radiation or radioactive pharmaceuticals, is not contraindicated in patients with an implanted metallic device or who suffer from claustrophobia and it can be performed at the bedside. The purpose of this article is to outline the physiological principles underpinning ischaemia testing with MCE before proceeding to review the evidence base for MCE in patients with known or suspected coronary artery disease.

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