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Meta-Analysis and Systematic Review of the Long-Term Predictive Value of Assessment of Coronary Atherosclerosis by Contrast-Enhanced Coronary Computed Tomography Angiography
Open accessAbstract
Objectives We conducted a systematic review and meta-analysis to determine the predictive value of findings of coronary computed tomography angiography for incident cardiovascular events. Background Initial studies indicate a prognostic value of the technique; however, the level of evidence as well as exact independent risk estimates remain unclear. Methods We searched PubMed, EMBASE, and the Cochrane Library through January 2010 for studies that followed up ≥ 100 subjects for ≥ 1 year and reported at ≥ 1 hazard ratio (HR) of interest. Risk estimates for the presence of significant coronary stenosis (primary endpoint; ≥ 50% diameter stenosis), left main coronary artery stenosis, each coronary stenosis, 3-vessel disease, any plaque, per coronary segment containing plaque, and noncalcified plaque were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. Results We identified 11 eligible articles including 7,335 participants (age 59.1 ± 2.6 years, 62.8% male) with suspected coronary artery disease. The presence of ≥ 1 significant coronary stenosis (9 studies, 3,670 participants, and 252 outcome events [6.8%] with 62% revascularizations) was associated with an annualized event rate of 11.9% (6.4% in studies excluding revascularization). The corresponding HR was 10.74 (98% confidence interval [CI]: 6.37 to 18.11) and 6.15 (95% CI: 3.22 to 11.74) in studies excluding revascularization. Adjustment for coronary calcification did not attenuate the prognostic significance (p = 0.79). The estimated HRs for left main stenosis, presence of plaque, and each coronary segment containing plaque were 6.64 (95% CI: 2.6 to 17.3), 4.51 (95% CI: 2.2 to 9.3), and 1.23 (95% CI: 1.17 to 1.29), respectively. Conclusions Presence and extent of coronary artery disease on coronary computed tomography angiography are strong, independent predictors of cardiovascular events despite heterogeneity in endpoints, categorization of computed tomography findings, and study population.
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“However, male masters endurance athletes with seemingly low cardiovascular disease risk have shown an increased prevalence of high coronary artery calcium (CAC) scores and a greater number of coronary plaques compared with relatively sedentary counterparts of similar age.2–5”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [3]
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Metadata
- Authors
- Bamberg, F., Sommer, W. H., Hoffmann, V., Achenbach, S., Nikolaou, K., Conen, D., Reiser, M. F., Hoffmann, U., & Becker, C. R.
- Affiliations
- Harvard University (US)
- Ludwig-Maximilians-Universität München (DE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- University Hospital of Basel (CH)
- Corresponding author
- Bamberg, Fabian
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-06
- Volume
- 57
- Issue
- 24
- Pages
- 2426-2436
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2086160762
- Cited by
- 173
- References
- 28
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 6 · 2021: 8 · 2020: 7 · 2019: 4 · 2018: 8 · 2017: 16 · 2016: 14 · 2015: 19 · 2014: 23 · 2013: 23 · 2012: 23
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Siemens
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Artery Anomalies
- Keywords
- coronary artery disease, coronary CT angiography, incident cardiovascular events, prognostic value, coronary artery stenosis, left main coronary artery stenosis, coronary plaque, non-calcified plaque, coronary artery calcification, revascularization, long-term follow-up, risk stratification, coronary heart disease risk prediction, coronary artery disease risk
- MeSH terms
- Aged, Contrast Media, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Radiographic Image Enhancement, Severity of Illness Index, Tomography, X-Ray Computed, Survival Rate, Coronary Angiography, Risk Assessment
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