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Prognostic Value of Coronary Computed Tomographic Angiography for Prediction of Cardiac Events in Patients With Suspected Coronary Artery Disease
Open accessAbstract
Objectives We assessed the rate of cardiac events after detection or exclusion of obstructive coronary artery disease (CAD) by coronary computed tomography angiography (CCTA).Background Several studies have demonstrated a high diagnostic accuracy of CCTA for detection of obstructive CAD compared with invasive angiography, but data regarding the clinical prognostic value of CCTA are limited.Methods In all, 1,256 consecutive patients with suspected CAD undergoing 64-slice CCTA in our institution between October 2004 and September 2006 were observed prospectively for the occurrence of severe cardiac events (cardiac death, myocardial infarction, or unstable angina requiring hospitalization: primary study end point) and all cardiac events (additionally including revascularization >90 days after CCTA). The observed rate of all cardiac events was compared with the event rate predicted by the Framingham risk score. Obstructive CAD was defined as > or = 50% diameter stenosis in any coronary artery.Results During a median follow-up of 18 months (interquartile range 14 to 25 months), the overall rates of severe and all cardiac events were 0.6% and 1.8%, respectively. In 802 patients without obstructive CAD, there were 4 cardiac events, of which 1 was severe, whereas in 348 patients with obstructive CAD, there were 17 cardiac events, of which 5 were severe. The difference between the 2 groups was highly significant both for severe events (odds ratio: 17.3, 95% confidence interval: 3.6 to 82.5) and for all cardiac events (odds ratio: 16.1, 95% confidence interval: 7.2 to 36.0; both p < 0.001). The rate of all cardiac events in patients without obstructive CAD was significantly lower than predicted by the Framingham risk score (p = 0.01).Conclusions In patients with suspected CAD, CCTA has a significant prognostic impact on the prediction of cardiac events for the subsequent 18 months. The exclusion of obstructive CAD by CCTA identifies a patient population with an event risk lower than predicted by conventional risk factors.
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“The Agatston score is an independent risk marker regarding the extent of CHD 157 and prognostic impact.158”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [158]
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BackgroundMethodChanges in Preventive Medical Therapies and CV Risk Factors After CT Angiography
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Hulten, E. A., Bittencourt, M. S., Ghoshhajra, B. B., O’Leary, D. E., Christman, M. P., Blaha, M. J., Truong, Q. A., Nelson, K. A., Montana, P., Steigner, M. L., et al. (2014) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2013.12.029 · Cited by 66
Zacharias, K. A., Ahmed, A., Shah, B. N., Gurunathan, S., Young, G., Acosta, D., & Senior, R. (2016) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jew049 · Cited by 59
“The cut-off value of 50% was used as it has been previously shown to be prognostic.(17)”
MethodAdvancements in risk stratification and management strategies in primary cardiovascular prevention
Barkas, F., Şener, Y. Z., Golforoush, P. A., Kheirkhah, A., Rodríguez‐Sánchez, E., Novák, J., Apellániz-Ruiz, M., Akyea, R. K., Bianconi, V., Ceasovschih, A., et al. (2024) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2024.117579 · Cited by 61
Cesare, E. D., Carbone, I., Carriero, A., Centonze, M., COBELLI, F. D., Rosa, R. D., Renzi, P. D., Esposito, A., Faletti, R., Fattori, R., et al. (2012) · La radiologia medica · doi:10.1007/s11547-012-0814-x · Cited by 56
Schuhbaeck, A., Dey, D., Otaki, Y., Slomka, P. J., Kral, B. G., Achenbach, S. S., Berman, D. S., Fishman, E. K., Lai, S., & Lai, H. C. (2014) · European Radiology · doi:10.1007/s00330-014-3253-3 · Cited by 56
Habib, P. J., Green, J., Butterfield, R. C., Kuntz, G. M., Murthy, R., Kraemer, D. F., PERCY, R. F., Miller, A. B., & Strom, J. A. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2013.08.096 · Cited by 53
Technical challenges of coronary CT angiography: Today and tomorrow
Hassan, A., Nazir, S. A., & Alkadhi, H. (2010) · European Journal of Radiology · doi:10.1016/j.ejrad.2010.02.011 · Cited by 53
van Werkhoven, J. M., Gaemperli, O., Schuijf, J. D., Jukema, J. W., Kroft, L. J., Leschka, S., Alkadhi, H., Valenta, I., Pundziute, G., de Roos, A., et al. (2009) · Heart · doi:10.1136/hrt.2009.167353 · Cited by 52
Kunita, E., Yamamoto, H., Kitagawa, T., Ohashi, N., Oka, T., Utsunomiya, H., Urabe, Y., Tsushima, H., Awai, K., Budoff, M. J., et al. (2014) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2014.01.038 · Cited by 55
“The endpoint was defined as a coronary event, including cardiac death, non-fatal MI, or unstable angina requiring hospitalization, and late coronary revascularizations (percutaneous coronary intervention or coronary artery bypass grafts) 3 months after CT [23].”
MethodØvrehus, K. A., Schuhbaeck, A., Marwan, M., Achenbach, S. S., Nørgaard, B. L., Bøtker, H. E., & Dey, D. (2015) · Journal of cardiovascular computed tomography · doi:10.1016/j.jcct.2015.11.003 · Cited by 52
Park, G., Lee, S., Cho, Y., Kim, C. J., Cho, J. S., Park, M., Her, S., Ahn, J., Lee, J., Park, D., et al. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2013.11.028 · Cited by 48
Nilsson, L. E., Wieringa, W. G., Pundziūtė, G., Gjerde, M., Engvall, J. E., Swahn, E., & Jonasson, L. (2014) · PLoS ONE · doi:10.1371/journal.pone.0108183 · Cited by 45
Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention
Trimarchi, G., Pizzino, F., Paradossi, U., Gueli, I. A., Palazzini, M., Gentile, P., Di Spigno, F., Ammirati, E., Garascia, A., Tedeschi, A., et al. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11080245 · Cited by 45
“For instance, a 2009 study involving 1256 patients with suspected CAD demonstrated that CCTA had a significant prognostic impact on predicting cardiac events for over one year [93].”
BackgroundPrognostic Value of Coronary Computed Tomographic Angiography in Asymptomatic Patients
Hadamitzky, M., Meyer, T. S., Hein, F., Bischoff, B., Martinoff, S. A., Schömig, A., & Hausleiter, J. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2010.01.354 · Cited by 45
Self-citationDiagnostic and Prognostic Value
Schuijf, J. D., van Werkhoven, J. M., Bax, J. J., & van der Wall, E. E. (2012) · Springer eBooks · doi:10.1007/978-88-470-2522-6_28 · Cited by 42
Sommer, W. H., Albrecht, E., Bamberg, F., Schenzle, J. C., Johnson, T. R. C., Neumaier, K., Reiser, M. F., & Nikolaou, K. (2010) · American Journal of Roentgenology · doi:10.2214/ajr.10.4416 · Cited by 41
“Several studies have underlined the prognostic value of MDCT in patients with suspected CAD [3, 4].”
BackgroundLatent Tuberculosis Infection and Subclinical Coronary Atherosclerosis in Peru and Uganda
Huaman, M. A., Cecco, C. N. D., Bittencourt, M. S., Ticona, E., Kityo, C. M., Ballena, I., Nalukwago, S., Nazzinda, R., Huaroto, C. T., Azañero, R., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1934 · Cited by 40
“Obstructive CAD was defined by a CAD-RADS of 3 or greater, as previously described [25].”
BackgroundMethodCho, I., Shim, J., Chang, H., Sung, J. M., Hong, Y., Shim, H., Kim, Y. J., Choi, B. W., Min, J. K., Kim, J., et al. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.08.981 · Cited by 39
Prognostic Value of CT Angiography in Patients With Inconclusive Functional Stress Tests
Azevedo, C. F., Hadlich, M. S., Bezerra, S. G., Petriz, J. L., Alves, R. R., Souza, O., Rati, M. A. N., de Albuquerque, D. C., & Moll, J. (2011) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2011.02.017 · Cited by 38
Hulten, E. A., Bittencourt, M. S., Preston, R., Singh, A., Romagnolli, C., Ghoshhajra, B. B., Shah, R. V., Abbasi, S. A., Abbara, S., Nasir, K., et al. (2017) · Cardiovascular Diabetology · doi:10.1186/s12933-017-0496-8 · Cited by 40
Abuzaid, A., Saad, M. S., Addoumieh, A., Ha, L. D., Elbadawi, A., Mahmoud, A. N., Elgendy, A. Y., Abdelaziz, H. K., Barakat, A. F., Mentias, A. G., et al. (2021) · Coronary Artery Disease · doi:10.1097/mca.0000000000000974 · Cited by 37
Maffei, E., Seitun, S., Martini, C., Aldrovandi, A., Cervellin, G., Tedeschi, C., Guaricci, A. I., Messalli, G., Catalano, O. A., & Cademartiri, F. (2011) · La radiologia medica · doi:10.1007/s11547-011-0647-z · Cited by 33
Yu, M., Li, W., Lu, Z., Wei, M., Yan, J., & Zhang, J. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.03.021 · Cited by 33
Achenbach, S. S., Barkhausen, J., Beer, M., Beerbaum, P., Dill, T., Eichhorn, J., Fratz, S., Gutberlet, M., Hoffmann, M. H. K., Huber, A. M. A., et al. (2012) · Der Kardiologe · doi:10.1007/s12181-012-0417-8 · Cited by 33
The Role of Imaging in Cardiovascular Prevention: A Comprehensive Review
Carerj, M. L., Restelli, D., Poleggi, C., Bella, G. D., Zito, C., Manganaro, R., Piccione, M. C., Trimarchi, G., Farina, A., Micari, A., et al. (2025) · Journal of Cardiovascular Echography · doi:10.4103/jcecho.jcecho_26_25 · Cited by 33
Korosoglou, G., Giuşcă, S., Gitsioudis, G., Erbel, C., & Katus, H. A. (2014) · Frontiers in Physiology · doi:10.3389/fphys.2014.00291 · Cited by 31
“…clinically stable chest pain syndrome (Pundziute et al., 2007; Gaemperli et al., 2008; Aldrovandi et al., 2009; Carrigan et al., 2009; Gopal et al., 2009; Hadamitzky et al., 2009; Rubinshtein et al., 2009; van Werkhoven et al., 2009a, reviewed in Bamberg et al., 2011) and summarized in Table 5).”
BackgroundLong-Term Follow-Up of Patients With First-Time Chest Pain Having 64-Slice Computed Tomography
Sozzi, F. B., Civaia, F., Rossi, P., Robillon, J.-F., Rusek, S., Berthier, F., Bourlon, F., Iacuzio, L., Dreyfus, G., & Dor, V. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2010.10.006 · Cited by 28
Hubbard, L. C., Lipinski, J., Ziemer, B. P., Malkasian, S., Sadeghi, B., Javan, H., Groves, E. M., Dertli, B., & Molloi, S. Y. (2017) · Radiology · doi:10.1148/radiol.2017162821 · Cited by 29
“Fortunately, when CAD risk is accurately assessed with coronary or computed tomographic (CT) angiography and is managed appropriately with medical therapy or surgical intervention, long-term outcomes are improved (1).”
BackgroundMilanese, G., Silva, M., Ledda, R. E., Goldoni, M., Nayak, S. M., Bruno, L., Rossi, E., Maffei, E., Cademartiri, F., & Sverzellati, N. (2020) · International Journal of Cardiology · doi:10.1016/j.ijcard.2020.04.031 · Cited by 29
Age- and gender-specific differences in the prognostic value of CT coronary angiography
Yiu, K., de Graaf, F. R., Schuijf, J. D., van Werkhoven, J. M., Marsan, N. A., Veltman, C. E., Roos, A., Pazhenkottil, A. P., Kroft, L. J. M., Boersma, E. H., et al. (2011) · Heart · doi:10.1136/heartjnl-2011-300038 · Cited by 28
Hansen, M. W., Ginns, J. N., SENEVIRATNE, S. K., Slaughter, R., Premaratne, M., Samardhi, H., Harker, J., Lai, T., Walters, D., & Bett, N. (2010) · Heart Lung and Circulation · doi:10.1016/j.hlc.2010.01.004 · Cited by 26
“An dditional benefit may be the detection of non-obstructive oronary disease [7,8] or important non-cardiac disease 9] and defining prognosis [5,10].”
BackgroundMethodKim, H., Kim, Y.-J., Lee, S., Park, E., Paeng, J.-C., Kim, H., Lee, W., Cho, G., Zo, J., Choi, D., et al. (2014) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeu010 · Cited by 26
Leipsic, J. A., Labounty, T. M., Mancini, G. B. J., Heilbron, B. G., Taylor, C. M., Johnson, M. A., Hague, C. J., Earls, J. P., Ajlan, A. M., & Min, J. K. (2011) · American Journal of Roentgenology · doi:10.2214/ajr.10.5786 · Cited by 26
“Additionally, coronary CTA has been shown to provide valuable prognostic information in the evaluation of patients with chest pain symptoms [4–6].”
BackgroundGurunathan, S., Zacharias, K., Akhtar, M. M., Ahmed, A., Mehta, V. S., Karogiannis, N., Vamvakidou, A., Khattar, R., & Senior, R. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.01.112 · Cited by 25
Mingels, A. M. A., Joosen, I. A., Versteylen, M. O., Laufer, E. M., Winkens, M. H. M., Wildberger, J. E., van Dieijen‐Visser, M. P., & Hofstra, L. (2012) · PLoS ONE · doi:10.1371/journal.pone.0035059 · Cited by 24
“luminal stenosis on CCTA deprive prognosis significantly [27].”
BackgroundCho, I., Suh, J., Chang, H., Kim, K., Jeon, E. J., Choi, S. I., Cho, Y., Youn, T., Chae, I., Kim, C., et al. (2013) · Korean Circulation Journal · doi:10.4070/kcj.2013.43.3.154 · Cited by 24
Current trends in patients with chronic total occlusions undergoing coronary CT angiography
Opolski, M. P., Hartaigh, B. Ó., Berman, D. S., Budoff, M. J., Achenbach, S. S., Al-Mallah, M. H., Andreini, D., Cademartiri, F., Chang, H., Chinnaiyan, K. M., et al. (2015) · Heart · doi:10.1136/heartjnl-2014-306616 · Cited by 24
Self-citationYorgun, H., Canpolat, U., Aytemir, K., Hazırolan, T., Sunman, H., Ateş, A. H., ŞAHINER, L., Karahan, S., Kaya, E. B., Tokgözoğlu, L. S., et al. (2012) · International Journal of Cardiology · doi:10.1016/j.ijcard.2012.11.066 · Cited by 21
Metadata
- Authors
- Hadamitzky, M., Freißmuth, B., Meyer, T., Hein, F., Kastrati, A., Martinoff, S., Schömig, A., & Hausleiter, J.
- Affiliations
- Deutsches Herzzentrum München (DE)
- Corresponding author
- Hadamitzky, Martin
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 2
- Issue
- 4
- Pages
- 404-411
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- OpenAlex
- W2022807949
- Cited by
- 280
- References
- 21
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7 · 2023: 7 · 2022: 11 · 2021: 18 · 2020: 9 · 2019: 9 · 2018: 7 · 2017: 12 · 2016: 21 · 2015: 19 · 2014: 18 · 2013: 24 · 2012: 27
- FWCI
- 26.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Cardiovascular imaging (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- 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 › Cardiac Health and Mental Health
- Keywords
- coronary CT angiography, obstructive coronary artery disease, prognostic value, cardiac events, myocardial infarction, unstable angina, cardiovascular mortality, revascularization, Framingham risk score, risk prediction, 64-slice CT
- MeSH terms
- Aged, Female, Heart Diseases, Hospitalization, Humans, Male, Middle Aged, Myocardial Revascularization, Predictive Value of Tests, Prospective Studies, Risk Factors, Time Factors, Tomography, X-Ray Computed, Odds Ratio, Treatment Outcome, Coronary Angiography, Risk Assessment, Coronary Stenosis, Kaplan-Meier Estimate
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