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Cited by 321Cardiac Imaging and DiagnosticsCoronary Interventions and DiagnosticsCoronary Artery Anomalies

Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients

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Hou, Zhi-hui, Lu, Bin, Gao, Yang, Jiang, Shi-liang, Wang, Yang, Li, Wei, Budoff, Matthew J.·2012·JACC: Cardiovascular Imaging
DOI 10.1016/j.jcmg.2012.06.006
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Abstract

Objectives This study sought to evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CTA) for major adverse cardiac events (MACE). Background The prognostic value of CACS has been well described. Few studies use the rich information of coronary CTA to predict future clinical outcomes and compare CACS with coronary CTA. Methods We followed up 5,007 outpatients who were suspected of having coronary artery disease (CAD) and who underwent cardiac CTA. Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in coronary CTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results Follow-up was completed in 4,425 patients (88.4%), with a median follow-up period of 1,081 days. At the end of the follow-up period, 363 (8.2%) patients had experienced MACE. Cumulative probability of 3-year MACE increased across CT strata for CACS (CACS 0, 2.1%; CACS 1 to 100, 12.9%; CACS 101 to 400, 16.3%; and CACS >400, 33.8%; log-rank p < 0.001); for coronary CTA (no plaque 0.8%, nonobstructive disease 3.7%, 1-vessel disease 27.6%, 2-vessel disease 35.5%, and 3-vessel disease 57.7%; log-rank p < 0.001); and for characteristics of the plaques (5.5% for calcified plaque, 22.7% for noncalcified plaque, and 37.7% for mixed plaque; log-rank p < 0.001). The area under the receiver-operating characteristic curves showed the incremental value of CACS and coronary CTA for predicting MACE: 0.71 for clinical risk factors, which improved to 0.82 by adding CACS and further improved to 0.93 by adding coronary CTA (both p < 0.001). Conclusions The CACS and coronary CTA findings have prognostic value and have incremental value over routine risk factors for MACE, and coronary CTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value.

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  • Calcified plaques are more stable and less prone to rupture than mixed and non-calcified plaques.

    “Since calcified plaques are more stable and less prone to rupture than mixed and non-calcified plaques”

    From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [20]

    The Discussion (page unavailable) reports significantly higher three-year major adverse cardiac event rates for noncalcified and mixed plaques than for calcified plaques, and describes soft, lipid-filled plaques as more vulnerable. The study does not establish that calcified plaques are mechanically more stable or specifically less prone to rupture; it measured clinical events, not plaque rupture. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Partially calcified and noncalcified plaques are more vulnerable to plaque rupture than calcified plaques.

    “This is clinically relevant because these plaque types are more vulnerable to plaque rupture than calcified plaques.10,11”

    From Wearable-Derived Training Load and Coronary Atherosclerosis in Middle-Aged and Older Athletes and Physically Active Controls: A New Perspective From the Master@Heart Study (2026) · cites this paper as [10]

    The Discussion reports higher three-year major adverse cardiac event rates for noncalcified and mixed plaques than for calcified plaques, and describes soft, lipid-filled plaques as vulnerable. The paper does not report a comparison of plaque-rupture rates for these plaque types, so the rupture-specific claim goes beyond its findings. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The type of plaque is important for the risk of cardiac events, with a lower risk attributed to calcified plaques compared to non-calcified and mixed plaques.

    “the type of plaque is important for the risk of cardiac events 3 , with a lower risk attributed to calcified plaques compared to non-calcified and mixed plaques”

    From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [3]

  • In patients suspected of having coronary artery disease, the estimated 3-year probability of major adverse cardiac events is 6% for calcified plaques, 23% for non-calcified plaques, and 38% for mixed plaques.

    “A previous study estimated the 3-year probability of major adverse cardiac events at 6% for calcified plaques, 23% for non-calcified plaques and 38% for mixed plaques in a cohort of patients suspected of having coronary artery disease 3 .”

    From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [3]

  • In patients suspected of having coronary artery disease, the estimated 3-year probability of major adverse cardiac events is 2.1% for CAC score=0, 13% for CAC score 1 to 100, 16% for CAC score 101 to 400, and 34% for CAC score above 400.

    “However, the difference between CAC=0 and CAC>0 is significant, with estimated 3-year probabilities of major adverse cardiac events of 2.1% for CAC score=0; 13% for a CAC score between 1 to 100; 16% for CAC score between 101 and 400; and 34% for a CAC score above 400 3 .”

    From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [3]

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Research works printed but not linked: 4

  1. Smith SC Jr., Greenland P, Grundy SM. Beyond secondary prevention: identifying the high-risk patient for primary prevention: executive sum- mary. Circulation 2000;101:111-6.
  2. Diverse Populations Collaborative Group. Prediction of mortality from coronary heart disease among diverse populations. Heart 2002;88:222-8.
  3. Shah PK. Pathophysiology of coro- nary thrombosis. Prog Cardiovasc Dis 2002;44:357-68.
  4. Wong ND, Detrano RC, Diamond G, et al. Does coronary artery screen- ing by electron beam computed to- mography motivate potentially bene- ficial lifestyle behaviors? Am J Cardiol 1996;78:1220 -3.

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Authors
Hou, Z.-H., Lu, B., Gao, Y., Jiang, S.-L., Wang, Y., Li, W., & Budoff, M. J.
Affiliations
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • Harbor–UCLA Medical Center (US)
ORCID
Venue
JACC: Cardiovascular Imaging
Publisher
Elsevier BV
Published
2012-10
Volume
5
Issue
10
Pages
990-999
ISSN
  • 1876-7591 (ISSN-L)
  • 1936-878X
DOI
10.1016/j.jcmg.2012.06.006
OpenAlex
W2093627517
Cited by
321
References
33
Citations by year
2026: 12 · 2025: 17 · 2024: 26 · 2023: 31 · 2022: 22 · 2021: 33 · 2020: 38 · 2019: 19 · 2018: 18 · 2017: 20 · 2016: 27 · 2015: 23 · 2014: 17 · 2013: 15 · 2012: 2
FWCI
13.78
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC. Cardiovascular imaging (publishedVersion)
  • PubMed (publishedVersion)
Funders
Ministry of Science and Technology of China (2007BAI05B02)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Coronary Artery Anomalies
Keywords
coronary artery calcium score, coronary CT angiography, major adverse cardiac events, coronary artery disease, prognostic value, plaque composition, non-calcified plaque, mixed plaque, calcified plaque, coronary stenosis severity, risk stratification, outpatients, incremental prognostic value, myocardial infarction, coronary revascularization, cardiovascular mortality, risk prediction model, incremental area under the curve
MeSH terms
Aged, Ambulatory Care, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Outpatients, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk Factors, ROC Curve, Severity of Illness Index, Time Factors, Chi-Square Distribution, Proportional Hazards Models, Coronary Angiography, Disease Progression, Risk Assessment, Area Under Curve, Kaplan-Meier Estimate, Vascular Calcification, Multidetector Computed Tomography

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