Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

Abstract

Background:Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center.Methods:We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis), non-obstructive (<50% stenosis), and no coronary artery disease (no angiographic disease). Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization) were obtained.Results:Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13–34 months), the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001). The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001).Conclusion:Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was associated with a significantly increased incidence of ischemic stroke. There was also a direct correlation between the severity of coronary artery disease on CCTA and cardiovascular prognosis over the follow-up period of 24 months.

The lack of obstructive coronary artery disease on coronary CT angiography safely reduces downstream cost and resource utilization during subsequent chest pain presentations

“…Outcomes in these patients have been previously published. 14 Patients were categorized by CCTA-identified stenosis, defined as no CAD, nonobstructive CAD (<50% maximal diameter stenosis), or obstructive CAD (!50% stenosis), to evaluate the effect of CAD burden on subsequent chest pain clinical evaluations, downstream cardiac testing, and direct costs of care after the index CCTA. This analysis represents a subpopulation of these patients that presented after their initial CCTA for downstream chest pain evaluations defined as outpatient or ED encounter for chest pain based on ICD-9 codes.…”

Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography

“…62e66 This is important to the military population in a constant state of deployment to global theater of operations, where not only is the cost of evacuation of symptomatic individuals extremely high, but it is also extremely detrimental to the mission's in currently lean operational force. The investigation of coronary CTA in military aircrew has also demonstrated the value of coronary CTA over CACS 81 and this is likely to be highly relevant to civil aviation and others at high occupational risk, such as the transport industry and emergency services.…”

Comparison and Optimization of Cardiovascular Risk Scores in Predicting the 4-Year Outcome of Patients with Obstructive Coronary Arteries Disease

“…Coronary artery disease (CAD) remains the leading cause of death in the world. 1 Serious clinical trials [2][3][4] demonstrated that patients with obstructive CAD had a higher likelihood to develop fatal or non-fatal cardiovascular events, compared to those with non-obstructive CAD. It is important to accurately stratify the risk of future cardiovascular events in CAD patients.…”