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For: Barros AJ, Blázquez MA, Leta R, Pujadas S, Alomar X, Pons-Lladó G. Coronariografía no invasiva mediante tomografía computarizada con multidetectores en pacientes con sospecha de enfermedad coronaria y ergometría no diagnóstica. Med Clin (Barc) 2009;132:661-4. [DOI: 10.1016/j.medcli.2008.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 06/17/2008] [Indexed: 10/20/2022]

For:	Barros AJ, Blázquez MA, Leta R, Pujadas S, Alomar X, Pons-Lladó G. Coronariografía no invasiva mediante tomografía computarizada con multidetectores en pacientes con sospecha de enfermedad coronaria y ergometría no diagnóstica. Med Clin (Barc) 2009;132:661-4. [DOI: 10.1016/j.medcli.2008.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 06/17/2008] [Indexed: 10/20/2022]

Number

Cited by Other Article(s)

Jiang B, Wang J, Lv X, Cai W. Prognostic value of cardiac computed tomography angiography in patients with suspected coronary artery disease: a meta-analysis. Cardiology 2014;128:304-12. [PMID: 24903842 DOI: 10.1159/000360131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/29/2014] [Indexed: 11/19/2022]

Bittencourt MS, Hulten E, Ghoshhajra B, O’Leary D, Christman MP, Montana P, Truong QA, Steigner M, Murthy VL, Rybicki FJ, Nasir K, Gowdak LHW, Hainer J, Brady TJ, Di Carli MF, Hoffmann U, Abbara S, Blankstein R. Prognostic Value of Nonobstructive and Obstructive Coronary Artery Disease Detected by Coronary Computed Tomography Angiography to Identify Cardiovascular Events. Circ Cardiovasc Imaging 2014;7:282-91. [DOI: 10.1161/circimaging.113.001047] [Citation(s) in RCA: 264] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]

Abstract Background— The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography. Methods and Results— All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (<50% stenosis), or obstructive (≥50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (≤4 segments) or extensive (>4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1–5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5–6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3–6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2–7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction. Conclusions— Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment. Collapse

Affiliation(s)

Marcio Sommer Bittencourt From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Edward Hulten From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Brian Ghoshhajra From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Daniel O’Leary From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Mitalee P. Christman From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Philip Montana From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Quynh A. Truong From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Michael Steigner From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Venkatesh L. Murthy From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Frank J. Rybicki From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Khurram Nasir From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Luis Henrique W. Gowdak From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Jon Hainer From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Thomas J. Brady From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Marcelo F. Di Carli From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Udo Hoffmann From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Suhny Abbara From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,
Ron Blankstein From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.S.B., E.H., D.O., M.P.C., P.M., M.S., F.J.R., J.H., M.F.D.C., R.B.); Heart Institute (InCor), University of São Paulo, São Paulo, Brazil (M.S.B., L.H.W.G.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (B.G., H.W.G., T.J.B., U.H., S.A.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital,

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Cheezum MK, Hulten EA, Fischer C, Smith RM, Slim AM, Villines TC. Prognostic Value of Coronary CT Angiography. Cardiol Clin 2012;30:77-91. [DOI: 10.1016/j.ccl.2011.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]

Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC. Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol 2010;57:1237-47. [PMID: 21145688 DOI: 10.1016/j.jacc.2010.10.011] [Citation(s) in RCA: 304] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 09/15/2010] [Accepted: 10/04/2010] [Indexed: 01/23/2023]

Abstract

OBJECTIVES

The purpose of this study was to systematically review and perform a meta-analysis of the ability of cardiac computed tomography angiography (CCTA) to predict future cardiovascular events and death.

BACKGROUND

The diagnostic accuracy of CCTA is well reported. The prognostic value of CCTA has been described in several studies, but many were underpowered. Pooling outcomes increases the power to predict rare events.

METHODS

We searched multiple databases for longitudinal studies of CCTA with at least 3 months follow-up of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), consisting of death, myocardial infarction (MI), and revascularization. Annualized event rates were pooled using a bivariate mixed-effects binomial regression model to calculate summary likelihood ratios and receiver-operating characteristic curves.

RESULTS

Eighteen studies evaluated 9,592 patients with a median follow-up of 20 months. The pooled annualized event rate for obstructive (any vessel with >50% luminal stenosis) versus normal CCTA was 8.8% versus 0.17% per year for MACE (p < 0.05) and 3.2% versus 0.15% for death or MI (p < 0.05). The pooled negative likelihood ratio for MACE after normal CCTA findings was 0.008 (95% confidence interval [CI]: 0.0004 to 0.17, p < 0.001), the positive likelihood ratio was 1.70 (95% CI: 1.42 to 2.02, p < 0.001), sensitivity was 0.99 (95% CI: 0.93 to 1.00, p < 0.001), and specificity was 0.41 (95% CI: 0.31 to 0.52, p < 0.001). Stratifying by no CAD, nonobstructive CAD (worst stenosis <50%), or obstructive CAD, there were incrementally increasing adverse events.

CONCLUSIONS

Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.

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