Repeat Coronary Computed Tomographic Angiography in Patients With a Prior Scan Excluding Significant Stenosis

Abstract

Computed Tomography (AUC2010) does not incorporate prior coronary computed tomographic angiography (CCTA) results in the appropriateness of a CCTA examination. The purpose of this study was to explore the criteria for forgoing repeat CCTA among patients with clinical scenarios suggesting CCTA as appropriate after prior CCTA excluding coronary artery disease. Methods and Results-Among patients from a single center (February 2006 to April 2013) who underwent appropriate CCTA based on AUC2010, consecutive 555 CCTAs, which had a prior CCTA excluding significant stenosis (>50% stenosis in diameter), were selected. The median time difference between the studies was 34.2 (Q1-Q3, 22.9-50.1) months. Significant stenosis was detected at the time of repeat scan (by CCTA or subsequent catheter angiography) in 13.3% (74 of 555). A multivariable logistic model (C-statistic, 0.74; bootstrapped overfitting bias, 0.8%) identified 3 predictors of significant stenosis: time difference between the studies >3 years (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.5), diabetes mellitus (odds ratio, 2.4; 95% confidence interval,1.4-4.3), and 26% to 50% stenosis on the initial CCTA (odds ratio, 5.6; 95% confidence interval, 3.2-9.6). When these 3 factors were all absent (corresponding to 31.9% of the population), the probability of significant stenosis was 4.5% (95% confidence interval, 2.7-7.4%), whereas 17.1% of patients had significant stenosis among those with at least 1 positive variable. When coronary arteries were completely normal at the initial scan, the prevalence of significant stenosis was only 1.8% irrespective of other factors, and no patient underwent revascularization. Conclusions-Nondiabetic patients with a prior CCTA <3 years showing no or ≤25% stenosis had a <5% prevalence of significant stenosis.

Progression of coronary atherosclerotic plaque burden and relationship with adverse cardiovascular event in asymptomatic diabetic patients

“…Conceivably, repeat CCTA at an intermediate time-point after the initiation of optimized medical therapy may inform granular custom-tailoring of the treatment regimen based on the individual progression pattern of the coronary plaque burden. Although current Appropriate Use Criteria for Cardiac Computed Tomography do not incorporate prior CCTA results [27], the value of serial CCTA may warrant more consideration, especially for asymptomatic diabetic patients at high risk who may benefit from personalized risk stratification and modification of optimized medical therapy [28].…”

Coronary Artery Disease is More Severe in Patients with Non-Alcoholic Steatohepatitis than Fatty Liver

“…This weighted score was then multiplied by the area (in square millimeters) of the coronary calcification. The recently proposed Society of Cardiovascular Computed Tomography grading scale for CAS severity was used to assess the degree of luminal stenosis [19], in which Grade 0 represented no visible stenosis, Grade 1 represented 1-24% (minimal stenosis), Grade 2 represented 25-49% (mild stenosis), Grade 3 represented 50-69% (moderate stenosis), Grade 4 represented 70-99% (severe stenosis), and Grade 5 represented 100% (occlusion). The features of high-risk (non-calcified) plaques were defined as positive remodeling, CT attenuation < 30 HU, "napkin-ring" sign, and only spots of calcium deposition.…”

Relation between Coronary Artery Calcium Score and Cardiovascular Events in Hodgkin Lymphoma Survivors: A Cross-Sectional Matched Cohort Study

“…Segments were defined uninterpretable in the case of low contrast enhancement or severe motion artifact as the presence of plaques cannot be excluded due to bad image quality. Interpretable segments were evaluated for stenosis and classified into three categories: no CAD (no plaque or stenosis), non-obstructive (<50% stenosis), and obstructive CAD (≥50% stenosis) according to prior studies [15]. Plaque characteristics were assessed in the presence of plaque and defined as non-calcified, mixed, or calcified [16].…”