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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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European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
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2016 European Guidelines on cardiovascular disease prevention in clinical practice
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M.-T., Corrà, U., Cosyns, B., Deaton, C., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw106 · Cited by 6,457
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab484 · Cited by 6,485
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European guidelines on cardiovascular disease prevention in clinical practice: executive summary
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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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