Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography

Ostrom, Matthew P.; Gopal, Ambarish; Ahmadi, Naser; Nasir, Khurram; Yang, Eric H.; Kakadiaris, Ioannis A.; Flores, Ferdinand; Mao, Song; Budoff, Matthew J.

doi:10.1016/j.jacc.2008.07.027

Cited by 338 publications

(224 citation statements)

References 27 publications

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“…However, this finding is consistent with recent controversial research findings on all-cause mortality (Okamura et al 2008) and contributes to the growing debate of the role of total cholesterol in health (Weverling-Rijnsburger et al 1997). Higher levels of atherosclerosis also decreased the risk of survival to 85, which aligns with findings from cardiovascular studies of all-cause mortality (Ostrom et al 2008). These findings demonstrate that risk factors shown in younger adults can also predict survival to age 85, although perhaps to a lesser extent.…”

Section: Discussionsupporting

confidence: 82%

Predicting survival and morbidity-free survival to very old age

Newson

Witteman

Franco

et al. 2010

AGE

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As life expectancy continually increases, it is imperative to identify determinants of survival to the extreme end of the lifespan and more importantly to identify factors that increase the chance of survival free of major morbidities. As such, the current study assessed 45 common disease factors as predictors of survival and morbidity-free survival to age 85 years. Within the Rotterdam Study, a population-based cohort, we evaluated morbidity-free participants who were able to attain age 85 within the study duration (n=2,008). Risk factors were assessed at baseline (1990)(1991)(1992)(1993), and mortality and morbidities were then collected continuously until mortality or the occurrence of their 85th birthday (average time of 7.9 years). Risk factors included demographic and lifestyle variables, health and morbidity indicators and physiological makers. Major morbidities examined included dementia, cancer, cerebrovascular accident, heart failure and myocardial infarction. Logistic regression analyses demonstrated that many of the variables were independently predictive for survival and for morbidity-free ageing to 85 years. These included being female, absence of left ventricular abnormalities, stable body weight, unimpaired instrumental activities of daily living, lower C-RP levels and higher levels of femoral neck bone mineral density and albumin. Relative to nonsurvival, predictors were stronger for morbidity-free survival than for total survival or survival with morbidity. This suggests that lifespan and healthy survival to older age can be relatively well predicted. Understanding predictors of a long and healthy lifespan is vital for developing primary and secondary preventions to help improve the quality of life of older adults and for reducing the financial burden of the rapidly escalating ageing population.

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Section: Discussionsupporting

confidence: 82%

Predicting survival and morbidity-free survival to very old age

Newson

Witteman

Franco

et al. 2010

AGE

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“…Several studies have explored the prognostic value of CCTA, primarily limited to symptomatic populations. 67, 68 Hadamitsky et al reported new data on CCTA that predicted both death and MI, as well as the need for subsequent revascularizations out to 5 years. 69 CCTA imaging may be a valuable tool for assessment of long-term prognosis in patients with suspected CAD (Table 4).…”

Section: Disclosuresmentioning

confidence: 99%

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Sato

Aonuma

2015

Circ J

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712SATO A et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp for detecting coronary artery stenosis has been compared with ICA. Several studies have demonstrated the ability of CCTA to detect anatomically significant CAD with high negative predictive value (NPV). The CORE 64 study demonstrated that the patient-based diagnostic accuracy of quantitative CCTA for detecting stenoses ≥50% according to ICA revealed an area under the curve (AUC) of 0.93, with sensitivity of 85%, specificity of 90%, positive predictive value (PPV) of 91%, and NPV of 83%. 7 The 64-slice CCTA is accurate in identifying coronary stenoses and characterizing disease severity in symptomatic patients who have coronary artery calcium scores (CACS) <600. Given its PPV of 91% and NPV of 83%, 64-slice CCTA cannot replace conventional ICA. The substudy of CORE 64 showed that the AUC for diagnostic accuracy was similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pretest probability for CAD, and known CAD, whereas the NPV was different (0.90, 0.83, and 0.50, respectively). For excluding obstructive CAD, CCTA was less effective in patients with calcium score ≥600 and high pretest probability for obstructive CAD. 13 In the CONFIRM study, the prevalence of observed CAD with either ≥50% diameter stenosis (CAD50) or 70% diameter stenosis (CAD70) was substantially lower than predicted by guideline probabilities in the overall population (18% vs. 51% for CAD50, 10% vs.ultidetector computed tomography (MDCT) is well established for more precise evaluation of coronary stenosis relative to electron-beam CT. 1-3 Multicenter studies have confirmed the accuracy of 64-slice MDCT for directly visualizing and detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). 4-7 Furthermore, dual-source CT (DSCT), 256-slice, and 320-detector scanner were developed to significantly improve scan times, volume coverage, and spatial resolution. 8-12 With improvement in the technical aspects of coronary computed tomography angiography (CCTA), clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion imaging (MPI), and patient outcomes. In this review, we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion. Diagnosis of CAD Role of Cardiac Multidetector Computed Tomography Beyond Coronary AngiographyAkira Sato, MD; Kazutaka Aonuma, MD, PhDCardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinica...

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“…In recent years, a large number of studies have assessed the role played by magnetic resonance and CT not only for the diagnostic evaluation 13,[31][32][33][34][35][36][37][38][39] , but also for the prognostic evaluation [40][41][42][43][44][45][46][47] of patients with cardiovascular diseases. Regarding cardiac CT, a recent series of studies have shown that, not only the CACS assessment, but also the assessment of coronary anatomy by use of CCTA provide important prognostic information in patients suspected of having significant CAD 42,44,45,[47][48][49] .…”

Section: Prognostic Valuementioning

confidence: 99%

“…Regarding cardiac CT, a recent series of studies have shown that, not only the CACS assessment, but also the assessment of coronary anatomy by use of CCTA provide important prognostic information in patients suspected of having significant CAD 42,44,45,[47][48][49] . Using a 16-row detector CT device, Min et al 44 have studied 1,127 patients and assessed the relationship between all-cause mortality and the results of CCTA.…”

Section: Prognostic Valuementioning

confidence: 99%

See 1 more Smart Citation

Escore de cálcio e angiotomografia coronariana na estratificação do risco cardiovascular

Azevedo¹,

Rochitte²,

Lima

2012

Arq. Bras. Cardiol.

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Cardiovascular disease is the leading mortality cause worldwide. The capacity to identify among the asymptomatic individuals the subgroup at greater risk for developing cardiovascular events is fundamental in any strategy aimed at reducing the rate of cardiovascular events. The first step in cardiovascular risk stratification is the use of global risk scores, the Framingham risk score being the most frequently used. However, previous studies have shown that, although very useful, clinical scores, when used alone, have a limited capacity for stratifying cardiovascular risk in a significant part of the population.In that context, coronary artery calcium score (CACS) and coronary computed tomographic angiography might play an important role as complementary tools for risk stratification of asymptomatic patients. The CACS provides important prognostic information that is incremental to clinical scores based on traditional risk factors and other diagnostic modalities, such as C-reactive protein measurement. In addition, CACS has the potential to change and help the patients' clinical management. On the other hand, coronary computed tomographic angiography provides a detailed assessment of the anatomy of the coronary arteries, allowing visualizing not only the lumen, but also the coronary arterial walls. Compared with conventional invasive coronary angiography, coronary computed tomographic angiography has excellent accuracy to identify and mainly exclude the presence of significant obstructive lesions. In addition, it proved to be able to provide incremental prognostic information to traditional risk factors and CACS.

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Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography

Abstract: The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.

Cited by 338 publications

References 27 publications

Predicting survival and morbidity-free survival to very old age

Predicting survival and morbidity-free survival to very old age

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Escore de cálcio e angiotomografia coronariana na estratificação do risco cardiovascular

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