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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.

Authors
 Todd C. Villines  ;  Edward A. Hulten  ;  Leslee J. Shaw  ;  Manju Goyal  ;  Allison Dunning  ;  Stephan Achenbach  ;  Mouaz Al-Mallah  ;  Daniel S. Berman  ;  Matthew J. Budoff  ;  Filippo Cademartiri  ;  Tracy Q. Callister  ;  Hyuk-Jae Chang  ;  Victor Y. Cheng  ;  Kavitha Chinnaiyan  ;  Benjamin J.W. Chow  ;  Augustin Delago  ;  Martin Hadamitzky  ;  Jörg Hausleiter  ;  Philipp Kaufmann  ;  Fay Y. Lin  ;  Erica Maffei  ;  Gilbert L. Raff 
Citation
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.58(24) : 2533-2540, 2011 
Journal Title
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN
 0735-1097 
Issue Date
2011
MeSH
Calcinosis/complications ; Calcinosis/diagnostic imaging* ; Coronary Angiography* ; Coronary Artery Disease/complications ; Coronary Artery Disease/diagnostic imaging* ; Coronary Artery Disease/mortality ; Coronary Artery Disease/therapy ; Coronary Stenosis/complications ; Coronary Stenosis/diagnostic imaging* ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Prognosis ; Proportional Hazards Models ; Registries ; Risk Factors ; Sensitivity and Specificity ; Tomography, X-Ray Computed*
Keywords
computed tomography ; coronary artery disease ; coronary calcium score ; coronary computed tomography angiography ; prognosis
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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0735109711045359
DOI
10.1016/j.jacc.2011.10.851
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/95146
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