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Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry.

Title
Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry.
Authors
Todd C. Villines;Edward A. Hulten;Gilbert L. Raff;Erica Maffei;Fay Y. Lin;Philipp Kaufmann;Jörg Hausleiter;Martin Hadamitzky;Augustin Delago;Benjamin J.W. Chow;Kavitha Chinnaiyan;Victor Y. Cheng;Hyuk-Jae Chang;Tracy Q. Callister;Filippo Cademartiri;Matthew J. Budoff;Daniel S. Berman;Mouaz Al-Mallah;Stephan Achenbach;Allison Dunning;Manju Goyal;Leslee J. Shaw
Issue Date
2011
Journal Title
Journal of the American College of Cardiology
ISSN
0735-1097
Citation
Journal of the American College of Cardiology, Vol.58(24) : 2533~2540, 2011
Abstract
OBJECTIVES: The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). BACKGROUND: The frequency and clinical relevance of CAD in patients without CAC are unclear. METHODS: We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. RESULTS: Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). CONCLUSIONS: In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.
URI
http://www.sciencedirect.com/science/article/pii/S0735109711045359

http://ir.ymlib.yonsei.ac.kr/handle/22282913/95146
DOI
10.1016/j.jacc.2011.10.851
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
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