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1. Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score

Author

van Rosendael, Alexander R, Shaw, Leslee J, Xie, Joe X, Dimitriu-Leen, Aukelien C, Smit, Jeff M, Scholte, Arthur J, van Werkhoven, Jacob M, Callister, Tracy Q, DeLago, Augustin, Berman, Daniel S, Hadamitzky, Martin, Hausleiter, Jeorg, Al-Mallah, Mouaz H, Budoff, Matthew J, Kaufmann, Philipp A, Raff, Gilbert, Chinnaiyan, Kavitha, Cademartiri, Filippo, Maffei, Erica, Villines, Todd C, Kim, Yong-Jin, Feuchtner, Gudrun, Lin, Fay Y, Jones, Erica C, Pontone, Gianluca, Andreini, Daniele, Marques, Hugo, Rubinshtein, Ronen, Achenbach, Stephan, Dunning, Allison, Gomez, Millie, Hindoyan, Niree, Gransar, Heidi, Leipsic, Jonathon, Narula, Jagat, Min, James K, and Bax, Jeroen J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Atherosclerosis, Biomedical Imaging, Prevention, Patient Safety, Cardiovascular, Clinical Research, Heart Disease - Coronary Heart Disease, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Adult, Aged, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Coronary Stenosis, Coronary Vessels, Female, Humans, Male, Middle Aged, Multidetector Computed Tomography, Myocardial Infarction, Plaque, Atherosclerotic, Predictive Value of Tests, Progression-Free Survival, Reproducibility of Results, Risk Assessment, Risk Factors, Severity of Illness Index, coronary computed tomography angiography, risk stratification, stable coronary artery disease, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

ObjectivesThis study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS).BackgroundCurrent risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification.MethodsA total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971).ResultsThe mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort.ConclusionsThe new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).

Published
2019

10. Superior risk stratification with coronary CTA using a comprehensive atherosclerotic risk score

Author

van Rosendael, Alexander R., Shaw, Leslee J., Xie, Joe X., Dimitriu-Leen, Aukelien C., Smit, Jeff M., Scholte, Arthur J., van Werkhoven, Jacob M., Callister, Tracey Q., DeLago, Augustin, Berman, Daniel S., Hadamitzky, Martin, Hausleiter, Jeorg, Al-Mallah, Mouaz H., Budoff, Matthew J., Kaufmann, Philipp A., Raff, Gilbert, Chinnaiyan, Kavitha, Cademartiri, Filippo, Maffei, Erica, Villines, Todd C., Yong-Jin, Kim, Feuchtner, Gudrun, Lin, Fay Y., Jones, Erica C., Pontone, Gianluca, Andreini, Daniele, Marques, Hugo, Rubinshtein, Ronen, Achenbach, Stephan, Dunning, Allison, Gomez, Millie, Hindoyan, Niree, Gransar, Heidi, Leipsic, Jonathon, Narula, Jagat, Min, James K., and Bax, Jeroen J.

Subjects
Computed Tomography Angiography, Humans, Heart, cardiovascular diseases, Coronary Angiography, Tomography, X-Ray Computed, Risk Assessment, Article
Abstract

OBJECTIVES: To assess the prognostic value of a new, comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease – Reporting and Data System (CAD-RAD S). BACKGROUND: Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location and composition in a comprehensive model may improve risk stratification. METHODS: A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0–42 and divided into three groups: 0–5, 6–20, and >20) was compared with the CAD-RADS combined into 3 groups (0 – 30%, 30 – 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (CONFIRM) registry, n = 1,971). RESULTS: Patients mean age was 55±13 years, mean follow-up 3.6 ± 2.8 years and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score demonstrated strong and independent predictive value using Cox proportional hazard analysis. A model including clinical variables + comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables + CAD-RADS (0.768 vs 0.742, P=0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with conventional approach (net reclassification improvement 12.4%, P

Published
2019

11. Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography

Author

Veltman, Caroline E., de Graaf, Fleur R., Schuijf, Joanne D., van Werkhoven, Jacob M., Jukema, J. Wouter, Kaufmann, Philipp A., Pazhenkottil, Aju P., Kroft, Lucia J., Boersma, Eric, Bax, Jeroen J., Schalij, Martin J., van der Wall, Ernst E., Veltman, Caroline E., de Graaf, Fleur R., Schuijf, Joanne D., van Werkhoven, Jacob M., Jukema, J. Wouter, Kaufmann, Philipp A., Pazhenkottil, Aju P., Kroft, Lucia J., Boersma, Eric, Bax, Jeroen J., Schalij, Martin J., and van der Wall, Ernst E.

Abstract

Aims Limited information is available regarding the relationship between coronary vessel dominance and prognosis. Therefore, the purpose of this study was to determine the prognostic value of coronary vessel dominance in relation to significant coronary artery disease (CAD) in patients referred for computed tomography coronary angiography (CTA). Methods and results The study population consisted of 1425 patients (869 men, 57 ± 12 years) referred for CTA. To evaluate the impact of vessel dominance and significant CAD on CTA on outcome, patients were followed during a median period of 24 months for the occurrence of non-fatal myocardial infarction and all-cause mortality. The presence of a left dominant system was identified as a significant predictor for non-fatal myocardial infarction and all-cause mortality (HR: 3.20; 95% CI: 1.67-6.13, P < 0.001) and had incremental value over baseline risk factors and severity of CAD on CTA. In addition, in the subgroup of patients with significant CAD on CTA, patients with a left dominant system had a worse outcome compared with patients with a right dominant system (cumulative event rates: 9.5% and 35% at 3-year follow-up for a right and left dominant coronary artery system, respectively, log-rank P < 0.001). Conclusions The presence of a left dominant system was identified as an independent predictor of non-fatal myocardial infarction and all-cause mortality, especially in patients with significant CAD on CTA. Therefore, the assessment of coronary vessel dominance on CTA may further enhance risk stratification beyond the assessment of significant CAD on CTA

Published
2017

12. Influence of smoking on the prognostic value of cardiovascular computed tomography coronary angiography

Author

van Werkhoven, Jacob M., Schuijf, Joanne D., Pazhenkottil, Aju P., Herzog, Bernard A., Ghadri, Jelena R., Jukema, J. Wouter, Boersma, Eric, Kroft, Lucia J., de Roos, Albert, Kaufmann, Philipp A., Bax, Jeroen J., van Werkhoven, Jacob M., Schuijf, Joanne D., Pazhenkottil, Aju P., Herzog, Bernard A., Ghadri, Jelena R., Jukema, J. Wouter, Boersma, Eric, Kroft, Lucia J., de Roos, Albert, Kaufmann, Philipp A., and Bax, Jeroen J.

Abstract

Aims Computed tomography coronary angiography (CTA) is an important non-invasive imaging modality increasingly used for the diagnosis and prognosis of coronary artery disease (CAD). The purpose of the current study was to determine the influence of smoking status on the prognostic value of CTA in patients with suspected or known CAD. Methods and results In 1207 patients (57% male, age 57 ± 12 years) referred for CTA, the presence of significant CAD (≥50% stenosis) was determined. During follow-up (FU) the following events were recorded: all cause mortality, and non-fatal infarction. The prognostic value of CTA in smokers and non-smokers was compared using an interaction term in the Cox proportional hazard regression analysis. Significant CAD was observed in 327 patients (27%), and 273 patients (23%) were smokers. During a median FU time of 2.2 years, an event occurred in 50 patients. After correction for baseline characteristics including smoking in a multivariate model, significant CAD remained an independent predictor of events. Furthermore, a significant interaction (P < 0.05) was observed between significant CAD and smoking. The annualized event rate in smokers with significant CAD was 8.78% compared with 0.99% in smokers without significant CAD (P < 0.001). In non-smokers with significant CAD the annualized event rate was 2.07% compared with 1.01% in non-smokers without significant CAD (P= 0.058). Conclusion The prognostic value of CTA was significantly influenced by smoking status. The event rates in patients with significant CAD were approximately four-fold higher in smokers compared with non-smokers. These findings suggest that smoking cessation needs to be aggressively pursued, especially in smokers with significant CAD

Published
2017

13. Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease

Author

van Werkhoven, Jacob M., Schuijf, Joanne D., Gaemperli, Oliver, Jukema, J. Wouter, Kroft, Lucia J., Boersma, Eric, Pazhenkottil, Aju, Valenta, Ines, Pundziute, Gabija, de Roos, Albert, van der Wall, Ernst E., Kaufmann, Philipp A., Bax, Jeroen J., van Werkhoven, Jacob M., Schuijf, Joanne D., Gaemperli, Oliver, Jukema, J. Wouter, Kroft, Lucia J., Boersma, Eric, Pazhenkottil, Aju, Valenta, Ines, Pundziute, Gabija, de Roos, Albert, van der Wall, Ernst E., Kaufmann, Philipp A., and Bax, Jeroen J.

Abstract

Aims The purpose of this study was to assess the relationship between calcium scoring (CS) and multi-slice computed tomography coronary angiography (MSCTA) and to determine if MSCTA has an incremental prognostic value to CS. Methods and results In 432 patients (59% male, age 58 ± 11 years) referred for cardiac evaluation owing to suspected coronary artery disease (CAD), CS and 64-slice MSCTA were performed. The following events were combined in a composite endpoint: all-cause mortality, non-fatal infarction, and unstable angina requiring revascularization. CS was 0 in 147 (34%) patients, CS 1-99 was present in 122 (28%), CS 100-399 in 75 (17%), CS 400-999 in 56 (13%), and CS ≥ 1000 in 32 (7%). MSCTA was normal in 133 (31%) patients, MSCTA 30-50% stenosis was observed in 190 (44%), and MSCTA ≥50% stenosis in 109 (25%). During follow-up [median 670 days (25th-75th percentile: 418-895)], an event occurred in 21 patients (4.9%). After multivariate correction for CS, MSCTA ≥ 50% stenosis, the number of diseased segments, obstructive segments, and non-calcified plaques were independent predictors with an incremental prognostic value to CS. Conclusion MSCTA provides additional information to CS regarding stenosis severity and plaque composition. This additional information was shown to translate into incremental prognostic value over CS

Published
2017

14. Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography

Author

Veltman, Caroline E, de Graaf, Fleur R, Schuijf, Joanne D, van Werkhoven, Jacob M, Jukema, J Wouter, Kaufmann, Philipp A, Pazhenkottil, Aju P, Kroft, Lucia J, Boersma, Eric, Bax, Jeroen J, Schalij, Martin J, van der Wall, Ernst E, Veltman, Caroline E, de Graaf, Fleur R, Schuijf, Joanne D, van Werkhoven, Jacob M, Jukema, J Wouter, Kaufmann, Philipp A, Pazhenkottil, Aju P, Kroft, Lucia J, Boersma, Eric, Bax, Jeroen J, Schalij, Martin J, and van der Wall, Ernst E

Abstract

AIMS: Limited information is available regarding the relationship between coronary vessel dominance and prognosis. Therefore, the purpose of this study was to determine the prognostic value of coronary vessel dominance in relation to significant coronary artery disease (CAD) in patients referred for computed tomography coronary angiography (CTA). METHODS AND RESULTS: The study population consisted of 1425 patients (869 men, 57 ± 12 years) referred for CTA. To evaluate the impact of vessel dominance and significant CAD on CTA on outcome, patients were followed during a median period of 24 months for the occurrence of non-fatal myocardial infarction and all-cause mortality. The presence of a left dominant system was identified as a significant predictor for non-fatal myocardial infarction and all-cause mortality (HR: 3.20; 95% CI: 1.67-6.13, P < 0.001) and had incremental value over baseline risk factors and severity of CAD on CTA. In addition, in the subgroup of patients with significant CAD on CTA, patients with a left dominant system had a worse outcome compared with patients with a right dominant system (cumulative event rates: 9.5% and 35% at 3-year follow-up for a right and left dominant coronary artery system, respectively, log-rank P < 0.001). CONCLUSIONS: The presence of a left dominant system was identified as an independent predictor of non-fatal myocardial infarction and all-cause mortality, especially in patients with significant CAD on CTA. Therefore, the assessment of coronary vessel dominance on CTA may further enhance risk stratification beyond the assessment of significant CAD on CTA.

Published
2012

16. INVASIVE CORONARY ANGIOGRAPHIC AND REVASCULARIZATION RATES AFTER NON-INVASIVE COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY

Author

Rianne de Graaf, Fleur, primary, Schuijf, Joanne D., additional, de Boer, Stephanie M., additional, van Werkhoven, Jacob M., additional, van Velzen, Joëlla E., additional, Kroft, Lucia J., additional, de Roos, Albert, additional, Jukema, J. Wouter, additional, Schalij, Martin J., additional, van der Wall, Ernst E., additional, and Bax, Jeroen J., additional

Published
2011
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17. INCREMENTAL PROGNOSTIC VALUE OF RENAL DYSFUNCTION FOR THE PREDICTION OF CLINICAL OUTCOME IN PATIENTS UNDERGOING COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY

Author

Hang Yiu, Kai, primary, Schuijf, Joanne D., additional, van Werkhoven, Jacob M., additional, de Graaf, Fleur R., additional, van Velzen, Joella D., additional, Boogers, Mark J., additional, Roos, C.J., additional, Pazhenkottil, Aju, additional, Jukema, J Wouter, additional, Kroft, Lucia J., additional, Boersma, Eric, additional, Herzog, Bernhard, additional, de Roos, Albert, additional, Kaufmann, Philipp A., additional, and Bax, Jeroen J., additional

Published
2011
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18. Predictive Value of Multislice Computed Tomography Variables of Atherosclerosis for Ischemia on Stress-Rest Single-Photon Emission Computed Tomography

Author

van Velzen, Joëlla E., primary, Schuijf, Joanne D., additional, van Werkhoven, Jacob M., additional, Herzog, Bernhard A., additional, Pazhenkottil, Aju P., additional, Boersma, Eric, additional, de Graaf, Fleur R., additional, Scholte, Arthur J., additional, Kroft, Lucia J., additional, de Roos, Albert, additional, Stokkel, Marcel P., additional, Jukema, J. Wouter, additional, Kaufmann, Philipp A., additional, van der Wall, Ernst E., additional, and Bax, Jeroen J., additional

Published
2010
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19. Reduced Left Ventricular Torsion Early After Myocardial Infarction Is Related to Left Ventricular Remodeling

Author

Nucifora, Gaetano, primary, Marsan, Nina Ajmone, additional, Bertini, Matteo, additional, Delgado, Victoria, additional, Siebelink, Hans-Marc J., additional, van Werkhoven, Jacob M., additional, Scholte, Arthur J., additional, Schalij, Martin J., additional, van der Wall, Ernst E., additional, Holman, Eduard R., additional, and Bax, Jeroen J., additional

Published
2010
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20. ACCURACY OF NON-INVASIVE MULTISLICE COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY; DETECTION OF SIGNIFICANT STENOSIS VERSUS DETECTION OF ATHEROSCLEROSIS

Author

Velzen, Joella E., primary, Schuijf, Joanne D., additional, de Graaf, Fleur R., additional, Pundziute, Gabija, additional, Spano, Fabrizio, additional, van Werkhoven, Jacob M., additional, Schalij, Martin J., additional, Kroft, Lucia J., additional, de Roos, Albert, additional, Reiber, Johannes H., additional, Jukema, J. Wouter, additional, van der Wall, Ernst E., additional, and Bax, Jeroen J., additional

Published
2010
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21. LEFT VENTRICULAR TORSION EARLY AFTER MYOCARDIAL INFARCTION: ITS DETERMINANTS AND ABILITY TO PREDICT LEFT VENTRICULAR REMODELING

Author

Nucifora, Gaetano, primary, Bertini, Matteo, additional, Marsan, Nina Ajmone, additional, Delgado, Victoria, additional, Ng, Arnold CT, additional, Holman, Eduard R., additional, Siebelink, Hans-Mark J., additional, Van Werkhoven, Jacob M., additional, Van Der Wall, Ernst E., additional, Schalij, Martin J., additional, and Bax, Jeroen J., additional

Published
2010
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23. Reply

Author

Meijboom, W. Bob, primary, Meijs, Matthijs F.L., additional, Schuijf, Joanne D., additional, Cramer, Maarten J., additional, Mollet, Nico R., additional, van Mieghem, Carlos A.G., additional, Nieman, Koen, additional, van Werkhoven, Jacob M., additional, Pundziute, Gabija, additional, Weustink, Annick C., additional, de Vos, Alexander M., additional, Pugliese, Francesca, additional, Rensing, Benno, additional, Jukema, J. Wouter, additional, Bax, Jeroen J., additional, Prokop, Mathias, additional, Doevendans, Pieter A., additional, Hunink, Myriam G., additional, Krestin, Gabriel P., additional, and de Feyter, Pim J., additional

Published
2009
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24. Prevalence of Coronary Artery Disease Assessed by Multislice Computed Tomography Coronary Angiography in Patients With Paroxysmal or Persistent Atrial Fibrillation

Author

Nucifora, Gaetano, primary, Schuijf, Joanne D., additional, Tops, Laurens F., additional, van Werkhoven, Jacob M., additional, Kajander, Sami, additional, Jukema, J. Wouter, additional, Schreur, Joop H.M., additional, Heijenbrok, Mark W., additional, Trines, Serge A., additional, Gaemperli, Oliver, additional, Turta, Olli, additional, Kaufmann, Philipp A., additional, Knuuti, Juhani, additional, Schalij, Martin J., additional, and Bax, Jeroen J., additional

Published
2009
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25. Prognostic Value of Multislice Computed Tomography and Gated Single-Photon Emission Computed Tomography in Patients With Suspected Coronary Artery Disease

Author

van Werkhoven, Jacob M., primary, Schuijf, Joanne D., additional, Gaemperli, Oliver, additional, Jukema, J. Wouter, additional, Boersma, Eric, additional, Wijns, William, additional, Stolzmann, Paul, additional, Alkadhi, Hatem, additional, Valenta, Ines, additional, Stokkel, Marcel P.M., additional, Kroft, Lucia J., additional, de Roos, Albert, additional, Pundziute, Gabija, additional, Scholte, Arthur, additional, van der Wall, Ernst E., additional, Kaufmann, Philipp A., additional, and Bax, Jeroen J., additional

Published
2009
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26. Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography

Author

Meijboom, W. Bob, primary, Meijs, Matthijs F.L., additional, Schuijf, Joanne D., additional, Cramer, Maarten J., additional, Mollet, Nico R., additional, van Mieghem, Carlos A.G., additional, Nieman, Koen, additional, van Werkhoven, Jacob M., additional, Pundziute, Gabija, additional, Weustink, Annick C., additional, de Vos, Alexander M., additional, Pugliese, Francesca, additional, Rensing, Benno, additional, Jukema, J. Wouter, additional, Bax, Jeroen J., additional, Prokop, Mathias, additional, Doevendans, Pieter A., additional, Hunink, Myriam G.M., additional, Krestin, Gabriel P., additional, and de Feyter, Pim J., additional

Published
2008
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29. Noninvasive Evaluation With Multislice Computed Tomography in Suspected Acute Coronary Syndrome Plaque Morphology on Multislice Computed Tomography Versus Coronary Calcium Score

Author

Henneman, Maureen M., Schuijf, Joanne D., Pundziute, Gabija, van Werkhoven, Jacob M., van der Wall, Ernst E., Jukema, J. Wouter, and Bax, Jeroen J.

Subjects
MSCT, atherosclerosis, acute coronary syndrome
Abstract

ObjectivesOur aim was to evaluate the atherosclerotic plaque burden and morphology as determined by 64-slice multislice computed tomography (MSCT) coronary angiography in relation to the calcium score in patients presenting with suspected acute coronary syndrome (ACS).BackgroundThe absence of coronary calcium during coronary calcium scoring has been proposed to rule out significant coronary artery disease (CAD). However, data in patients presenting with suspected ACS are scarce.MethodsIn 40 patients (age 57 ± 11 years, 26 men) presenting with suspected ACS, MSCT coronary angiography in combination with coronary calcium scoring was performed before conventional coronary angiography. MSCT angiograms were evaluated for the presence or absence of coronary atherosclerotic plaque and the presence or absence of obstructive (≥50% luminal narrowing) CAD. In addition, plaque type was determined, and findings were related to the calcium score.ResultsCoronary artery disease was observed in 38 patients, of whom 10 patients had nonobstructive and 28 patients had obstructive CAD, confirmed by conventional coronary angiography in all patients. In patients with CAD, plaques were distributed as follows: 39% noncalcified plaques, 47% mixed plaques, and 14% calcified plaques. Coronary calcium was detected in 27 patients, of whom 10 had a score >400. In 13 (33%) patients, no coronary calcium was observed, but in 11 (85%), atherosclerotic plaques were detected on MSCT angiography.ConclusionsIn patients presenting with suspected ACS, noncalcified plaques are highly prevalent and the absence of coronary calcium does not reliably exclude the presence of (significant) atherosclerosis. This information may be of value to improve our understanding of the potential role of MSCT in this patient population.

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30. Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography A Prospective, Multicenter, Multivendor Study

Author

Meijboom, W. Bob, Meijs, Matthijs F.L., Schuijf, Joanne D., Cramer, Maarten J., Mollet, Nico R., van Mieghem, Carlos A.G., Nieman, Koen, van Werkhoven, Jacob M., Pundziute, Gabija, Weustink, Annick C., de Vos, Alexander M., Pugliese, Francesca, Rensing, Benno, Jukema, J. Wouter, Bax, Jeroen J., Prokop, Mathias, Doevendans, Pieter A., Hunink, Myriam G.M., Krestin, Gabriel P., and de Feyter, Pim J.

Subjects
computed tomography, multicenter, coronary angiography, prospective, coronary artery disease
Abstract

ObjectivesThis study sought to determine the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD).BackgroundCTCA is emerging as a noninvasive technique to detect coronary atherosclerosis.MethodsWe conducted a prospective, multicenter, multivendor study involving 360 symptomatic patients with acute and stable anginal syndromes who were between 50 and 70 years of age and were referred for diagnostic conventional coronary angiography (CCA) from September 2004 through June 2006. All patients underwent a nonenhanced calcium scan and a CTCA, which was compared with CCA. No patients or segments were excluded because of impaired image quality attributable to either coronary motion or calcifications. Patient-, vessel-, and segment-based sensitivities and specificities were calculated to detect or rule out significant CAD, defined as ≥50% lumen diameter reduction.ResultsThe prevalence among patients of having at least 1 significant stenosis was 68%. In a patient-based analysis, the sensitivity for detecting patients with significant CAD was 99% (95% confidence interval [CI]: 98% to 100%), specificity was 64% (95% CI: 55% to 73%), positive predictive value was 86% (95% CI: 82% to 90%), and negative predictive value was 97% (95% CI: 94% to 100%). In a segment-based analysis, the sensitivity was 88% (95% CI: 85% to 91%), specificity was 90% (95% CI: 89% to 92%), positive predictive value was 47% (95% CI: 44% to 51%), and negative predictive value was 99% (95% CI: 98% to 99%).ConclusionsAmong patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes. A positive 64-slice CTCA scan often overestimates the severity of atherosclerotic obstructions and requires further testing to guide patient management.

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31. Influence of smoking on the prognostic value of cardiovascular computed tomography coronary angiography

Author

van Werkhoven, Jacob M., Schuijf, Joanne D., Pazhenkottil, Aju P., Herzog, Bernard A., Ghadri, Jelena R., Jukema, J. Wouter, Boersma, Eric, Kroft, Lucia J., de Roos, Albert, Kaufmann, Philipp A., Bax, Jeroen J., van Werkhoven, Jacob M., Schuijf, Joanne D., Pazhenkottil, Aju P., Herzog, Bernard A., Ghadri, Jelena R., Jukema, J. Wouter, Boersma, Eric, Kroft, Lucia J., de Roos, Albert, Kaufmann, Philipp A., and Bax, Jeroen J.

Abstract

Aims Computed tomography coronary angiography (CTA) is an important non-invasive imaging modality increasingly used for the diagnosis and prognosis of coronary artery disease (CAD). The purpose of the current study was to determine the influence of smoking status on the prognostic value of CTA in patients with suspected or known CAD. Methods and results In 1207 patients (57% male, age 57 ± 12 years) referred for CTA, the presence of significant CAD (≥50% stenosis) was determined. During follow-up (FU) the following events were recorded: all cause mortality, and non-fatal infarction. The prognostic value of CTA in smokers and non-smokers was compared using an interaction term in the Cox proportional hazard regression analysis. Significant CAD was observed in 327 patients (27%), and 273 patients (23%) were smokers. During a median FU time of 2.2 years, an event occurred in 50 patients. After correction for baseline characteristics including smoking in a multivariate model, significant CAD remained an independent predictor of events. Furthermore, a significant interaction (P < 0.05) was observed between significant CAD and smoking. The annualized event rate in smokers with significant CAD was 8.78% compared with 0.99% in smokers without significant CAD (P < 0.001). In non-smokers with significant CAD the annualized event rate was 2.07% compared with 1.01% in non-smokers without significant CAD (P= 0.058). Conclusion The prognostic value of CTA was significantly influenced by smoking status. The event rates in patients with significant CAD were approximately four-fold higher in smokers compared with non-smokers. These findings suggest that smoking cessation needs to be aggressively pursued, especially in smokers with significant CAD

32. Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography

Author

Veltman, Caroline E., de Graaf, Fleur R., Schuijf, Joanne D., van Werkhoven, Jacob M., Jukema, J. Wouter, Kaufmann, Philipp A., Pazhenkottil, Aju P., Kroft, Lucia J., Boersma, Eric, Bax, Jeroen J., Schalij, Martin J., van der Wall, Ernst E., Veltman, Caroline E., de Graaf, Fleur R., Schuijf, Joanne D., van Werkhoven, Jacob M., Jukema, J. Wouter, Kaufmann, Philipp A., Pazhenkottil, Aju P., Kroft, Lucia J., Boersma, Eric, Bax, Jeroen J., Schalij, Martin J., and van der Wall, Ernst E.

Abstract

Aims Limited information is available regarding the relationship between coronary vessel dominance and prognosis. Therefore, the purpose of this study was to determine the prognostic value of coronary vessel dominance in relation to significant coronary artery disease (CAD) in patients referred for computed tomography coronary angiography (CTA). Methods and results The study population consisted of 1425 patients (869 men, 57 ± 12 years) referred for CTA. To evaluate the impact of vessel dominance and significant CAD on CTA on outcome, patients were followed during a median period of 24 months for the occurrence of non-fatal myocardial infarction and all-cause mortality. The presence of a left dominant system was identified as a significant predictor for non-fatal myocardial infarction and all-cause mortality (HR: 3.20; 95% CI: 1.67-6.13, P < 0.001) and had incremental value over baseline risk factors and severity of CAD on CTA. In addition, in the subgroup of patients with significant CAD on CTA, patients with a left dominant system had a worse outcome compared with patients with a right dominant system (cumulative event rates: 9.5% and 35% at 3-year follow-up for a right and left dominant coronary artery system, respectively, log-rank P < 0.001). Conclusions The presence of a left dominant system was identified as an independent predictor of non-fatal myocardial infarction and all-cause mortality, especially in patients with significant CAD on CTA. Therefore, the assessment of coronary vessel dominance on CTA may further enhance risk stratification beyond the assessment of significant CAD on CTA

33. Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease

Author

van Werkhoven, Jacob M., Schuijf, Joanne D., Gaemperli, Oliver, Jukema, J. Wouter, Kroft, Lucia J., Boersma, Eric, Pazhenkottil, Aju, Valenta, Ines, Pundziute, Gabija, de Roos, Albert, van der Wall, Ernst E., Kaufmann, Philipp A., Bax, Jeroen J., van Werkhoven, Jacob M., Schuijf, Joanne D., Gaemperli, Oliver, Jukema, J. Wouter, Kroft, Lucia J., Boersma, Eric, Pazhenkottil, Aju, Valenta, Ines, Pundziute, Gabija, de Roos, Albert, van der Wall, Ernst E., Kaufmann, Philipp A., and Bax, Jeroen J.

Abstract

Aims The purpose of this study was to assess the relationship between calcium scoring (CS) and multi-slice computed tomography coronary angiography (MSCTA) and to determine if MSCTA has an incremental prognostic value to CS. Methods and results In 432 patients (59% male, age 58 ± 11 years) referred for cardiac evaluation owing to suspected coronary artery disease (CAD), CS and 64-slice MSCTA were performed. The following events were combined in a composite endpoint: all-cause mortality, non-fatal infarction, and unstable angina requiring revascularization. CS was 0 in 147 (34%) patients, CS 1-99 was present in 122 (28%), CS 100-399 in 75 (17%), CS 400-999 in 56 (13%), and CS ≥ 1000 in 32 (7%). MSCTA was normal in 133 (31%) patients, MSCTA 30-50% stenosis was observed in 190 (44%), and MSCTA ≥50% stenosis in 109 (25%). During follow-up [median 670 days (25th-75th percentile: 418-895)], an event occurred in 21 patients (4.9%). After multivariate correction for CS, MSCTA ≥ 50% stenosis, the number of diseased segments, obstructive segments, and non-calcified plaques were independent predictors with an incremental prognostic value to CS. Conclusion MSCTA provides additional information to CS regarding stenosis severity and plaque composition. This additional information was shown to translate into incremental prognostic value over CS

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