Prevalence and Severity of Coronary Artery Disease and Adverse Events Among Symptomatic Patients With Coronary Artery Calcification Scores of Zero Undergoing Coronary Computed Tomography Angiography

Villines, Todd C.; Hulten, Edward; Shaw, Leslee J.; Goyal, Manju; Dunning, Allison; Achenbach, Stephan; Al-Mallah, Mouaz; Berman, Daniel S.; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Cheng, Victor; Chinnaiyan, Kavitha M.; Chow, Benjamin J.W.; Delago, Augustin; Hadamitzky, Martin; Hausleiter, Jörg; Kaufmann, Philipp A.; Lin, Fay Y.; Maffei, Erica; Raff, Gilbert; Min, James K.; Investigators, Confirm

doi:10.1016/j.jacc.2011.10.851

Cited by 338 publications

(192 citation statements)

References 21 publications

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“…That almost half our cohort demonstrated noncalcified plaques highlights an important advantage of coronary CTA over calcium scoring alone, suggesting that asymptomatic OSA patients undergoing cardiovascular evaluation should have coronary CTA rather than calcium scoring if true plaque burden is to be assessed. Other studies have also found substantial plaque burden and a negative coronary calcium score in at-risk groups [33]. Although conjectural, our finding of a substantially higher prevalence of plaques in proximal coronary segments in high-AHI patients may have outcome implications, such proximal plaques are strongly associated in other high-risk groups with subsequent adverse cardiac events [34].…”

Section: Discussionsupporting

confidence: 44%

Severity of obstructive sleep apnoea predicts coronary artery plaque burden: a coronary computed tomographic angiography study

et al. 2013

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Obstructive sleep apnoea (OSA) is associated with significantly increased risk of cardiovascular disease. Carotid ultrasonography and retrospective, uncontrolled, coronary imaging studies have suggested an association of OSA with subclinical atherosclerosis, but there is a lack of prospective, controlled studies directly evaluating the relationship of OSA with occult coronary artery disease.We performed coronary computed tomographic angiography and inpatient-attended sleep studies on a cohort of otherwise healthy males attending our sleep laboratory, and compared coronary artery plaque volume between subjects with low and high apnoea/hypopnoea index (AHI) scores.29 subjects participated. The median AHI was 15.5 events?h -1 , with subjects who scored above this classified as high AHI. No significant differences were observed in demographic, anthropometric and clinical variables between the high-and low-AHI groups. Coronary plaque volume was significantly greater in the high-AHI group (mean plaque volume 2.6¡0.7 mm 2 versus 0.8¡0.2 mm 2 ; p50.017) and, furthermore, correlated significantly with AHI (Spearman's r50.433; p50.019). Following adjustment for dyslipidaemia and fasting plasma glucose levels, AHI remained a significant predictor of plaque volume (standardised b=0.424; p50.027).In this prospective case-control study, we found that severity of OSA may predict occult coronary atherosclerosis in otherwise healthy overweight or obese male subjects. @ERSpublications Increasing OSA severity predicts a greater burden of occult coronary artery disease in healthy overweight or obese males http://ow.ly/nSXEU

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Section: Discussionsupporting

confidence: 44%

Severity of obstructive sleep apnoea predicts coronary artery plaque burden: a coronary computed tomographic angiography study

et al. 2013

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“…This is in contrast to the results of the Coronary CT Angiography Evaluation for Clinical Outcomes (CONFIRM) registry, 7 in which symptomatic patients with a CACS of 0 AU had the same MACE rate as those with positive CACS values. It has to be noted, however, that the CONFIRM findings concerned only a small group of patients (1.8%) in whom obstructive coronary lesions were present.…”

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confidence: 95%

Prognostic value of coronary artery calcium score in patients with symptoms suggestive of coronary artery disease. Results from the Silesian Calcium Score (SILICAS) study

Parma¹,

Parma²,

J³

et al. 2016

Polish Archives of Internal Medicine

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“…Finally, although rare, significant coronary stenosis may be caused by noncalcified plaque in patients with CAC scores of 0. 20 As the correlation between CAC score and Adjusted for the effects of age, sex, body mass index, and traditional risk factors, which were significant in univariate analysis (diabetes mellitus and hypertension). CAC indicates coronary artery calcium (reference, CAC 0); CI, confidence interval; and OR, odds ratio.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Engbers

Timmer

Ottervanger

et al. 2016

Circ: Cardiovascular Imaging

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Background— The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established. Methods and Results— Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (>90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and ≥1000, respectively ( P <0.001). During a median follow-up of 940 days (25th to 75th percentile, 581–1377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score ≥1000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score ≥1000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score ≥1000: hazard ratio, 7.7; P <0.001 and large perfusion defect on SPECT: hazard ratio, 3.7; P <0.001). Conclusions— CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.

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Prevalence and Severity of Coronary Artery Disease and Adverse Events Among Symptomatic Patients With Coronary Artery Calcification Scores of Zero Undergoing Coronary Computed Tomography Angiography

Abstract: In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.

Cited by 338 publications

References 21 publications

Severity of obstructive sleep apnoea predicts coronary artery plaque burden: a coronary computed tomographic angiography study

Severity of obstructive sleep apnoea predicts coronary artery plaque burden: a coronary computed tomographic angiography study

Prognostic value of coronary artery calcium score in patients with symptoms suggestive of coronary artery disease. Results from the Silesian Calcium Score (SILICAS) study

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

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