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Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography
Objectives This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal ou...
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| Published in: | Journal of the American College of Cardiology 2008-10, Vol.52 (16), p.1335-1343 |
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| creator | Ostrom, Matthew P., MD Gopal, Ambarish, MD Ahmadi, Naser, MD Nasir, Khurram, MD, MPH Yang, Eric, MD Kakadiaris, Ioannis, PhD Flores, Ferdinand, BS Mao, Song S., MD Budoff, Matthew J., MD |
| description | Objectives This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies. Methods In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (≥50% luminal narrowing), mild CAD ( |
| doi_str_mv | 10.1016/j.jacc.2008.07.027 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69684419</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735109708025928</els_id><sourcerecordid>3242985951</sourcerecordid><originalsourceid>FETCH-LOGICAL-c614t-56dd1e30b4a35fa06425e8ef2aa682f784a9867ef985cc30f8a1a73d8f20fc83</originalsourceid><addsrcrecordid>eNqFksFq3DAQhkVpaTZpX6CHYijkZnckW7IEpbAsbRpI6SF7F1p5lMj1WlvJDuzbV2YXAjm0IEYD880PM_8Q8oFCRYGKz33VG2srBiAraCtg7SuyopzLsuaqfU1W0Na8pKDaC3KZUg8AQlL1llxQqZhiDV-R4WeIkxn8dCxuR-s7HC0WZuyK6RGLe3zCuJSCKzYhhtHEY7HOlRiSHZboU7FOCfPrit0xQ_vDPOV8G_bhIZrDY-bHB3_O35E3zgwJ35__K7L9_m27-VHe_bq53azvSitoM5VcdB3FGnaNqbkzIBrGUaJjxgjJXCsbo6Ro0SnJra3BSUNNW3fSMXBW1lfk-iR7iOHPjGnSe58sDoMZMcxJCyVk01D1X5ABa0Qtmgx-egH2YY5jnkFTDoIxKkBkip0omzeTIjp9iH6fd6Yp6MUx3evFMb04pqHV2bHc9PEsPe_22D23nC3KwJcTgHljTx6jTtYvNnU-op10F_y_9b--aLeDH701w288YnqeQyemQd8vN7OcDEhgXDFZ_wWHjLzz</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1506221606</pqid></control><display><type>article</type><title>Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><creator>Ostrom, Matthew P., MD ; Gopal, Ambarish, MD ; Ahmadi, Naser, MD ; Nasir, Khurram, MD, MPH ; Yang, Eric, MD ; Kakadiaris, Ioannis, PhD ; Flores, Ferdinand, BS ; Mao, Song S., MD ; Budoff, Matthew J., MD</creator><creatorcontrib>Ostrom, Matthew P., MD ; Gopal, Ambarish, MD ; Ahmadi, Naser, MD ; Nasir, Khurram, MD, MPH ; Yang, Eric, MD ; Kakadiaris, Ioannis, PhD ; Flores, Ferdinand, BS ; Mao, Song S., MD ; Budoff, Matthew J., MD</creatorcontrib><description>Objectives This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies. Methods In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (≥50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC). Results During a mean follow-up of 78 ± 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD. Conclusions 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.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2008.07.027</identifier><identifier>PMID: 18929245</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age Factors ; Aged ; Aged, 80 and over ; cardiac CT ; Cardiology ; Cardiovascular ; Cardiovascular disease ; Cause of Death ; Cohort Studies ; Confidence Intervals ; Contrast Media - pharmacology ; Coronary Angiography - methods ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - mortality ; Coronary Artery Disease - physiopathology ; coronary calcium ; Coronary vessels ; CT angiography ; Female ; Heart attacks ; Humans ; Incidence ; Internal Medicine ; Kaplan-Meier Estimate ; Male ; Medical imaging ; Middle Aged ; Mortality ; outcomes ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Radiographic Image Enhancement ; Risk Assessment ; ROC Curve ; Sensitivity and Specificity ; Severity of Illness Index ; Sex Factors ; Survival Analysis ; Tomography, X-Ray Computed - methods</subject><ispartof>Journal of the American College of Cardiology, 2008-10, Vol.52 (16), p.1335-1343</ispartof><rights>American College of Cardiology Foundation</rights><rights>2008 American College of Cardiology Foundation</rights><rights>Copyright Elsevier Limited Oct 14, 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c614t-56dd1e30b4a35fa06425e8ef2aa682f784a9867ef985cc30f8a1a73d8f20fc83</citedby><cites>FETCH-LOGICAL-c614t-56dd1e30b4a35fa06425e8ef2aa682f784a9867ef985cc30f8a1a73d8f20fc83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18929245$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ostrom, Matthew P., MD</creatorcontrib><creatorcontrib>Gopal, Ambarish, MD</creatorcontrib><creatorcontrib>Ahmadi, Naser, MD</creatorcontrib><creatorcontrib>Nasir, Khurram, MD, MPH</creatorcontrib><creatorcontrib>Yang, Eric, MD</creatorcontrib><creatorcontrib>Kakadiaris, Ioannis, PhD</creatorcontrib><creatorcontrib>Flores, Ferdinand, BS</creatorcontrib><creatorcontrib>Mao, Song S., MD</creatorcontrib><creatorcontrib>Budoff, Matthew J., MD</creatorcontrib><title>Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies. Methods In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (≥50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC). Results During a mean follow-up of 78 ± 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD. Conclusions 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.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>cardiac CT</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Confidence Intervals</subject><subject>Contrast Media - pharmacology</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>coronary calcium</subject><subject>Coronary vessels</subject><subject>CT angiography</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>outcomes</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Radiographic Image Enhancement</subject><subject>Risk Assessment</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Sex Factors</subject><subject>Survival Analysis</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqFksFq3DAQhkVpaTZpX6CHYijkZnckW7IEpbAsbRpI6SF7F1p5lMj1WlvJDuzbV2YXAjm0IEYD880PM_8Q8oFCRYGKz33VG2srBiAraCtg7SuyopzLsuaqfU1W0Na8pKDaC3KZUg8AQlL1llxQqZhiDV-R4WeIkxn8dCxuR-s7HC0WZuyK6RGLe3zCuJSCKzYhhtHEY7HOlRiSHZboU7FOCfPrit0xQ_vDPOV8G_bhIZrDY-bHB3_O35E3zgwJ35__K7L9_m27-VHe_bq53azvSitoM5VcdB3FGnaNqbkzIBrGUaJjxgjJXCsbo6Ro0SnJra3BSUNNW3fSMXBW1lfk-iR7iOHPjGnSe58sDoMZMcxJCyVk01D1X5ABa0Qtmgx-egH2YY5jnkFTDoIxKkBkip0omzeTIjp9iH6fd6Yp6MUx3evFMb04pqHV2bHc9PEsPe_22D23nC3KwJcTgHljTx6jTtYvNnU-op10F_y_9b--aLeDH701w288YnqeQyemQd8vN7OcDEhgXDFZ_wWHjLzz</recordid><startdate>20081014</startdate><enddate>20081014</enddate><creator>Ostrom, Matthew P., MD</creator><creator>Gopal, Ambarish, MD</creator><creator>Ahmadi, Naser, MD</creator><creator>Nasir, Khurram, MD, MPH</creator><creator>Yang, Eric, MD</creator><creator>Kakadiaris, Ioannis, PhD</creator><creator>Flores, Ferdinand, BS</creator><creator>Mao, Song S., MD</creator><creator>Budoff, Matthew J., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20081014</creationdate><title>Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography</title><author>Ostrom, Matthew P., MD ; Gopal, Ambarish, MD ; Ahmadi, Naser, MD ; Nasir, Khurram, MD, MPH ; Yang, Eric, MD ; Kakadiaris, Ioannis, PhD ; Flores, Ferdinand, BS ; Mao, Song S., MD ; Budoff, Matthew J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c614t-56dd1e30b4a35fa06425e8ef2aa682f784a9867ef985cc30f8a1a73d8f20fc83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>cardiac CT</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Confidence Intervals</topic><topic>Contrast Media - pharmacology</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>coronary calcium</topic><topic>Coronary vessels</topic><topic>CT angiography</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>outcomes</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Radiographic Image Enhancement</topic><topic>Risk Assessment</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Sex Factors</topic><topic>Survival Analysis</topic><topic>Tomography, X-Ray Computed - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ostrom, Matthew P., MD</creatorcontrib><creatorcontrib>Gopal, Ambarish, MD</creatorcontrib><creatorcontrib>Ahmadi, Naser, MD</creatorcontrib><creatorcontrib>Nasir, Khurram, MD, MPH</creatorcontrib><creatorcontrib>Yang, Eric, MD</creatorcontrib><creatorcontrib>Kakadiaris, Ioannis, PhD</creatorcontrib><creatorcontrib>Flores, Ferdinand, BS</creatorcontrib><creatorcontrib>Mao, Song S., MD</creatorcontrib><creatorcontrib>Budoff, Matthew J., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ostrom, Matthew P., MD</au><au>Gopal, Ambarish, MD</au><au>Ahmadi, Naser, MD</au><au>Nasir, Khurram, MD, MPH</au><au>Yang, Eric, MD</au><au>Kakadiaris, Ioannis, PhD</au><au>Flores, Ferdinand, BS</au><au>Mao, Song S., MD</au><au>Budoff, Matthew J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2008-10-14</date><risdate>2008</risdate><volume>52</volume><issue>16</issue><spage>1335</spage><epage>1343</epage><pages>1335-1343</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Objectives This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies. Methods In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (≥50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC). Results During a mean follow-up of 78 ± 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD. Conclusions 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>18929245</pmid><doi>10.1016/j.jacc.2008.07.027</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Factors Aged Aged, 80 and over cardiac CT Cardiology Cardiovascular Cardiovascular disease Cause of Death Cohort Studies Confidence Intervals Contrast Media - pharmacology Coronary Angiography - methods Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - mortality Coronary Artery Disease - physiopathology coronary calcium Coronary vessels CT angiography Female Heart attacks Humans Incidence Internal Medicine Kaplan-Meier Estimate Male Medical imaging Middle Aged Mortality outcomes Predictive Value of Tests Prognosis Proportional Hazards Models Radiographic Image Enhancement Risk Assessment ROC Curve Sensitivity and Specificity Severity of Illness Index Sex Factors Survival Analysis Tomography, X-Ray Computed - methods |
| title | Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography |
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