Daniele Andreini1, Gianluca Pontone2, Saima Mushtaq2, Heidi Gransar3, Edoardo Conte2, Antonio L Bartorelli2, Mauro Pepi2, Maksymilian P Opolski4, Bríain Ó Hartaigh5, Daniel S Berman3, Matthew J Budoff6, Stephan Achenbach7, Mouaz Al-Mallah8, Filippo Cademartiri9, Tracy Q Callister10, Hyuk-Jae Chang11, Kavitha Chinnaiyan12, Benjamin J W Chow13, Ricardo Cury14, Augustin Delago15, Martin Hadamitzky16, Joerg Hausleiter17, Gudrun Feuchtner18, Yong-Jin Kim19, Philipp A Kaufmann20, Jonathon Leipsic21, Fay Y Lin5, Erica Maffei22, Gilbert Raff12, Leslee J Shaw23, Todd C Villines24, Allison Dunning25, Hugo Marques26, Ronen Rubinshtein27, Niree Hindoyan28, Millie Gomez28, James K Min5. 1. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy. Electronic address: daniele.andreini@ccfm.it. 2. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy. 3. Department of Imaging and Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 4. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. 5. Department of Radiology, The New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 6. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA. 7. Department of Medicine, University of Erlangen, Erlangen, Germany. 8. King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdul Aziz Cardiac Center, Ministry of National Guard, Health Affairs, Saudi Arabia. 9. Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy. 10. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA. 11. Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea. 12. William Beaumont Hospital, Royal Oaks, MI, USA. 13. Department of Medicine and Radiology, University of Ottawa Heart Institute, Ontario, Canada. 14. Baptist Cardiac and Vascular Institute, Miami, FL, USA. 15. Capitol Cardiology Associates, Albany, NY, USA. 16. Division of Cardiology, Deutsches Herzzentrum München, Munich, Germany. 17. Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany. 18. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 19. Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea. 20. Department of Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland. 21. Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. 22. Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy. 23. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. 24. Department of Medicine, Walter Reed National Medical Center, Bethesda, MD, USA. 25. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA. 26. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 27. Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 28. Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA.
Abstract
BACKGROUND: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality. RESULTS: Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not. CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.
BACKGROUND:Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality. RESULTS:Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not. CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.
Authors: Issa Pour-Ghaz; Tamunoinemi Bob-Manuel; Hemnishil K Marella; Jayna Kelly; Amit Nanda; William Paul Skelton; Rami N Khouzam Journal: Ann Transl Med Date: 2018-01
Authors: Petar Medakovic; Zrinka Biloglav; Ivan Padjen; Ivan Pristas; Mladen Jukic; Franko Zuvela; Gordana Ivanac; Boris Brkljacic; Tena Jukic; Lana Turk Journal: Int J Cardiovasc Imaging Date: 2018-05-25 Impact factor: 2.357
Authors: Alexander R van Rosendael; A Maxim Bax; Jeff M Smit; Inge J van den Hoogen; Xiaoyue Ma; Subhi Al'Aref; Stephan Achenbach; Mouaz H Al-Mallah; Daniele Andreini; Daniel S Berman; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo C Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A Kaufmann; Yong-Jin Kim; Jonathon A Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L Raff; Ronen Rubinshtein; Todd C Villines; Heidi Gransar; Yao Lu; Jessica M Peña; Fay Y Lin; Leslee J Shaw; James K Min; Jeroen J Bax Journal: Eur Heart J Cardiovasc Imaging Date: 2020-05-01 Impact factor: 6.875
Authors: Jagat Narula; Y Chandrashekhar; Amir Ahmadi; Suhny Abbara; Daniel S Berman; Ron Blankstein; Jonathon Leipsic; David Newby; Edward D Nicol; Koen Nieman; Leslee Shaw; Todd C Villines; Michelle Williams; Harvey S Hecht Journal: J Cardiovasc Comput Tomogr Date: 2020-11-20
Authors: Rong Bing; James Henderson; Amanda Hunter; Michelle C Williams; Alastair J Moss; Anoop S V Shah; David A McAllister; Marc R Dweck; David E Newby; Nicholas L Mills; Philip D Adamson Journal: Heart Date: 2019-06-01 Impact factor: 5.994
Authors: Aline M A Martins; Mariana U B Paiva; Diego V N Paiva; Raphaela M de Oliveira; Henrique L Machado; Leonardo J S R Alves; Carolina R C Picossi; Andréa T Faccio; Marina F M Tavares; Coral Barbas; Viviane Z R Giraldez; Raul D Santos; Guilherme U Monte; Fernando A Atik Journal: Front Cardiovasc Med Date: 2021-12-22