Mortality Incidence of Patients With NonObstructive Coronary Artery Disease Diagnosed by
Computed Tomography Angiography
Naser Ahmadi, MD, Vahid Nabavi, MD, Fereshteh Hajsadeghi, MD, Ferdinand Flores, BS, William J.
French, MD, Song S. Mao, MD, David Shavelle, MD, Ramin Ebrahimi, MD, Matthew Budoff, MD
American Journal of Cardiology 2011;107:10-16
Presented By:
Spencer Peterson MSIII
Mercer University School of Medicine
June 27, 2011
Level B Class 1 Study
•
Purpose: Investigate long-term outcomes of
patients with non-obstructive CAD on the basis
of plaques
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Design/Method: Prospective observational
analysis of 3,499 symptomatic CAD subjects in
California. 1,102 of which had non-obstructive
CAD (luminal stenosis 1-49%), mean age 59+/14years and 69.9%men were followed for a
mean 78+/-12 months
•
Exclusions: irregular heart rate, allergies to contrast
media, previously known CAD, liver disease, and
impaired renal function
•
Main Outcome: predicting all-cause mortality in
symptomatic individuals with non-obstructive CAD
independent of age, gender, and conventional risk
factors.
•
Limitations: single center, use of all-cause mortality
instead of cardiac events, electron beam
angiography used when other radiological options
are available and radiation exposure consideration.
Coronary Artery Calcium
As Revealed by CTA
CAC Score and Events
http://www.lewrockwell.com/sardi/sardi126.html
Increased CAC = Increased Event Rate
CAC Increases with Age in Men
http://www.rockymountainmedicalimaging.com/PreventiveImaging/HeartScan.aspx
Conclusion
Death rate increased with the severity of CAC.
Death rate increased incrementally from calcified
plaque(1.4%) to mixed plaque(3.3%) to non-calcified
plaque(9.6%) as well as from single to triple vessel
disease. The presence and quality of plaque identified
by CTA can be used as a predictor in all-cause mortality
in symptomatic non-obstructive CAD.
Comment
•
Although many patients with symptomatic nonobstructive CAD are able to be D/C’ed home
without significant intervention at the time of
presentation. This study demonstrates an
important predictive value of mortality that can
directly relate to the patient’s prognosis.
Further studies need to be applied to more
regions and more advanced technology should
be used with reduced amounts of radiation
exposure.
Diagnostic Value of Coronary Artery Calcium
Scoring in Low-Intermediate Risk Patients
Evaluated in the Emergency Department for Acute
Coronary Syndrome
Leticia Fernandez-Friera, MD, Ana Garcia-Alvarez, MD, Fatemeh Badheriannejad-Esfahani, MD,
Waqas Malick, BS, Jesus G. Mirelis, MD, Simonette T. Sawit, MD, Valentin Fuster, MD, PhD, Javier
Sanz, MD, MarioJ. Garca, MD, Luke K. Hermann, MD
American Journal of Cardiology 2011;107:17-23
Funding: Instituto de Formacion e Investigacion “Marques de Valdecilla,” the Spanish Society of
Cardiology, and Centro Nacional de Investigacion Cardiovascular
Presented By:
Spencer Peterson MSIII
Mercer University School of Medicine
June 27, 2011
Level A Class IIa Study
•
Purpose: Determine the diagnostic utility of
CACS (coronary artery calcium scoring) in low
to intermediate risk patients presenting to
emergency departments with chest pain and
non-diagnostic ECG and cardiac enzyme
markers.
•
Design/Method: Retrospective study from
March 2007 to January 2009 in 225 patients in
ED with suspected acute coronary syndrome.
•
Exclusions: CAD >50%stenosis and/or previous
coronary revascularization
•
Main Outcome: CACS providing independent and
incremental information to give predictive value in
determining prognosis of patients at risk for CAD.
•
Limitations: few number of patients underwent
coronary angiography and thus severity of CAD not
confirmed. CCTA also tends to overestimate actual
prevalence of CAD. Prevalence of disease may vary
in different geographic regions.
CACS Results
•
Of the 225 cases studied for CAD:
•
Negative Predictive Value: 99%
•
Sensitivity: 91%
•
Specificity: 64%
•
Positive Predictive Value: 20%
TIMI Score
Comparing Sensitivities
and Specificities
•
Detecting Acute Coronary Syndrome Using Cardiac MRI:
Prospective Study Using MRI to Detect ACS
Conclusion
CACS has a high negative predictive value similar to that
of stress testing without any clinical contraindication (like
a-fib, heart defects, or need for contrast). It is
inexpensive, faster, simpler, and more available than
many other imaging techniques and involves about 10%
of the radiation that CCTA does. It is an effective tool in
providing additional diagnostic value in ACS.
Comment
•
The results of this study and many others show that
CACS can be used in formulating a diagnosis and
prognosis for patients presenting with ACS, but its
limitations to only providing a high negative
predictive value limit its use in providing clinical
intervention outside of discharging the patient.
Although p value was significant, the power of the
study was low. A cost analysis needs to accompany
this study.
Where Physicians Can
Impact CAD
http://healthpromotionadvocates.org/resources/briefing_doc.htm