Impact of Coronary Computed Tomographic Angiography Results on Patient and Physician Behavior in a Low-Risk Population

McEvoy, John W.; Blaha, Michael J.; Nasir, Khurram; Yoon, Yeonyee E.; Choi, Eue Keun; Cho, Ik Sung; Chun, Eun Ju; Choi, Sang Il; Rivera, Juan J.; Blumenthal, Roger S.; Chang, Hyuk Jae

doi:10.1001/archinternmed.2011.204

Cited by 60 publications

(39 citation statements)

References 34 publications

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“…In a comparable propensity score-based study of subclinical atherosclerosis imaging with coronary computed tomographic angiography, we reported similar results (comparing coronary computed tomographic angiography to usual care). 17 However, in contrast to our short-term study (18 months), Shreibati et al 19 found that CAC imaging was also associated with lower rates of the composite outcome of death, myocardial infarction, or stroke during a median of 3 years' follow-up (hazard ratio, 0.74; confidence interval, 0.58-0.94; P=0.017). This result is particularly notable given the findings of the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study, where hs-CRP was found to identify persons with normal cholesterol levels who derive benefit from statin therapy.…”

Section: Mcevoy and Blaha Comparative Effectiveness Of Cac Versus Hsccontrasting

confidence: 84%

“…One such strategy is the use of propensity-based matching to convert observational data into a form more akin to randomized controlled trial data by mimicking the effect of randomization. 17 Using observed covariates, propensity scores match subjects who receive an intervention (eg, CAC) with subjects who do not to balance the distribution of potential confounders of the outcome (eg, ASCVD events) in both groups. 18 However, unlike randomization, this strategy cannot balance unmeasured confounders.…”

Section: Article See P 655mentioning

confidence: 99%

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Coronary Artery Calcium Testing

McEvoy¹,

Blaha²

2014

Circ: Cardiovascular Imaging

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Section: Mcevoy and Blaha Comparative Effectiveness Of Cac Versus Hsccontrasting

confidence: 84%

Section: Article See P 655mentioning

confidence: 99%

Coronary Artery Calcium Testing

McEvoy¹,

Blaha²

2014

Circ: Cardiovascular Imaging

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“…Screening stress testing [67,[101][102][103] and CT coronary angiography [104] are considered inadequate means of assessing CAD risk in asymptomatic adults. Coronary calcium score may be helpful to determine the burden of CAD, but at this time the risk associated with a particular calcium score is unknown [105] and deemed an inappropriate marker for those at low risk [106].…”

Section: Ischemic Heart Diseasementioning

confidence: 99%

Part 2 - Sudden Cardiac Death in Athletes Focused Cause-and-Effect Screening

Paterick¹,

Choudhary²,

Chandrasekaran³

et al. 2015

JESO

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Echo/Doppler screening should be looked upon as a strategy used in a select population of healthy, asymptomatic individuals to identify pre-emergent disease. Using focused echo/Doppler screening the incidence of a cardiovascular finding in athletes has been reported to be roughly one case in every 170 athletes screened with a "false positive" finding in only 8 of 508 athletes [2,10,[13][14][15]. We describe how to provide a highest quality, exceptionally low cost pathophysiologic athletic screening test, which is validated to differentiate the status of a normal state from an abnormal life-threatening pathophysiologic state.Matching pre-emergent disease (without phenotypic expression) "associated" with sudden death through diastolic parameters is the key to differentiating normal from abnormal pathophysiology [5,9,[16][17][18][19][20][21][22][23][24]. These data are focused on two principal objectives: detect an imminent life-threatening state at a time when the opportunity for prevention is optimal [25,26], and define the magnitude of imminent risk that enlightens physician decision making and management [23,[26][27][28]. Rule-Out vs. Rule-in ScreeningA sensitive screening approach must be distinguished from a specific screening methodology [5,6]. The current trend in athletic screening is searching for an "abnormal" disease feature in a low risk population. This fact alone (searching for a specific rare event) is a major contributor to the controversies and shortfalls surrounding athletic screening [5,6].The most optimal screening test for a large, asymptomatic athletic population prioritizes testing to confirm wellness and rule out disease. An abnormality in screening would be referred for comprehensive evaluation. The rule out principle is important because the penalty for missing a disease has the potential for athletic death. This principle reduces the number of specific diseases to be considered during screening. All cardiomyopathies are grouped as having abnormal diastolic tissue Doppler examination. Conversely, ruling in a disease is more applicable when confirming a high frequency disease. Confirming wellness AbstractSudden death in an athlete is a tragic event. There is a strong social imperative to implement effective means of predicting and preventing sudden death in athletes. However, the design and implementation of a solution seems unobtainable [2]. Part Two discusses how novel attributes of systems biology and digital technology are capable of delivering high quality, low cost athletic screening. The merit of a transformative idea does not necessarily predict its adoption. The greatest barrier to change lies in the acquiescence to familiar practices even in light of new ideas and technology. The current thought in athletic screening is more centered on specific disease associations (rule-in principle), [3][4][5] and much less about the sensitivity of pathophysiologic causality (ruleout principle) [5][6][7][8].A solution will languish until the expert community takes direct action to embrace 21 s...

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“…Although CT calcium scoring allows identification of asymptomatic plaque burden, population-wide screening is currently not yet recommended. 5 Coronary CTA itself does not determine whether a stenotic lesion causes myocardial ischemia. Very recently, noninvasive fractional flow reserve derived from coronary CTA has high diagnostic performance for the detection and exclusion of coronary lesions that cause myocardial ischemia.…”

Section: Article P 2832mentioning

confidence: 99%

Impact of Ischemia-Guided Initial Diagnosis in Patients With Stable Angina

Tahara

2012

Circ J

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Impact of Coronary Computed Tomographic Angiography Results on Patient and Physician Behavior in a Low-Risk Population

Cited by 60 publications

References 34 publications

Coronary Artery Calcium Testing

Coronary Artery Calcium Testing

Part 2 - Sudden Cardiac Death in Athletes Focused Cause-and-Effect Screening

Impact of Ischemia-Guided Initial Diagnosis in Patients With Stable Angina

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