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Stephan Achenbach - One of the best experts on this subject based on the ideXlab platform.
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prognostic value of coronary Computed Tomographic Angiography findings in asymptomatic individuals a 6 year follow up from the prospective multicentre international confirm study
European Heart Journal, 2018Co-Authors: Iksung Cho, Heidi Gransar, Subhi J Alaref, Adam C Berger, Briain O Hartaigh, Valentina Valenti, Fay Y Lin, Stephan AchenbachAbstract:Aim The long-term prognostic benefit of coronary Computed Tomographic Angiography (CCTA) findings of coronary artery disease (CAD) in asymptomatic populations is unknown. Methods and results From the prospective multicentre international CONFIRM long-term study, we evaluated asymptomatic subjects without known CAD who underwent both coronary artery calcium scoring (CACS) and CCTA (n = 1226). Coronary Computed Tomographic Angiography findings included the severity of coronary artery stenosis, plaque composition, and coronary segment location. Using the C-statistic and likelihood ratio tests, we evaluated the incremental prognostic utility of CCTA findings over a base model that included a panel of traditional risk factors (RFs) as well as CACS to predict long-term all-cause mortality. During a mean follow-up of 5.9 ± 1.2 years, 78 deaths occurred. Compared with the traditional RF alone (C-statistic 0.64), CCTA findings including coronary stenosis severity, plaque composition, and coronary segment location demonstrated improved incremental prognostic utility beyond traditional RF alone (C-statistics range 0.71-0.73, all P 0.05, for all). Conclusions Coronary Computed Tomographic Angiography improved prognostication of 6-year all-cause mortality beyond a set of conventional RF alone, although, no further incremental value was offered by CCTA when CCTA findings were added to a model incorporating RF and CACS.
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relationship of hypertension to coronary atherosclerosis and cardiac events in patients with coronary Computed Tomographic Angiography
Hypertension, 2017Co-Authors: Rine Nakanishi, Heidi Gransar, Stephan Achenbach, Tracy Q Callister, Lohendran Baskaran, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Hyuk Jae Chang, Kavitha ChinnaiyanAbstract:Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary Computed Tomographic Angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary Computed Tomographic Angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events.
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incremental prognostic value of coronary Computed Tomographic Angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals
Atherosclerosis, 2014Co-Authors: James K Min, Stephan Achenbach, Tracy Q Callister, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Hyuk Jae Chang, Troy M Labounty, Millie Gomez, Victor Y ChengAbstract:Background Coronary artery disease (CAD) diagnosis by coronary Computed Tomographic Angiography (CCTA) is useful for identification of symptomatic diabetic individuals at heightened risk for death. Whether CCTA-detected CAD enables improved risk assessment of asymptomatic diabetic individuals beyond clinical risk factors and coronary artery calcium scoring (CACS) remains unexplored.
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performance of the traditional age sex and angina typicality based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary Computed Tomographic Angiography results from the multinational coronary ct Angiography evaluation for clinical outcomes an international multicenter registry confirm
Circulation, 2011Co-Authors: Victor Y Cheng, Stephan Achenbach, Daniel S Berman, Tracy Q Callister, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Alan Rozanski, Allison Dunning, Hyuk Jae ChangAbstract:Background—Guidelines for the management of patients with suspected coronary artery disease (CAD) rely on the age, sex, and angina typicality–based pretest probabilities of angiographically significant CAD derived from invasive coronary Angiography (guideline probabilities). Reliability of guideline probabilities has not been investigated in patients referred to noninvasive CAD testing. Methods and Results—We identified 14048 consecutive patients with suspected CAD who underwent coronary Computed Tomographic Angiography. Angina typicality was recorded with the use of accepted criteria. Pretest likelihoods of CAD with ≥50 diameter stenosis (CAD50) and ≥70 diameter stenosis (CAD70) were calculated from guideline probabilities. Computed Tomographic Angiography images were evaluated by ≥1 expert reader to determine the presence of CAD50 and CAD70. Typical angina was associated with the highest prevalence of CAD50 (40 in men, 19 in women) and CAD70 (27 men, 11 women) compared with other symptom categories (P<0...
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the ct stat coronary Computed Tomographic Angiography for systematic triage of acute chest pain patients to treatment trial
Journal of the American College of Cardiology, 2011Co-Authors: James A Goldstein, Sean W Hayes, Stephan Achenbach, Daniel S Berman, Kavitha Chinnaiyan, Aiden Abidov, Udo Hoffmann, John R Lesser, Issam Mikati, Brian J OneilAbstract:Objectives The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary Computed Tomographic Angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain. Background In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion. Methods This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up. Results The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p Conclusions In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325)
Tracy Q Callister - One of the best experts on this subject based on the ideXlab platform.
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relationship of hypertension to coronary atherosclerosis and cardiac events in patients with coronary Computed Tomographic Angiography
Hypertension, 2017Co-Authors: Rine Nakanishi, Heidi Gransar, Stephan Achenbach, Tracy Q Callister, Lohendran Baskaran, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Hyuk Jae Chang, Kavitha ChinnaiyanAbstract:Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary Computed Tomographic Angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary Computed Tomographic Angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events.
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incremental prognostic value of coronary Computed Tomographic Angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals
Atherosclerosis, 2014Co-Authors: James K Min, Stephan Achenbach, Tracy Q Callister, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Hyuk Jae Chang, Troy M Labounty, Millie Gomez, Victor Y ChengAbstract:Background Coronary artery disease (CAD) diagnosis by coronary Computed Tomographic Angiography (CCTA) is useful for identification of symptomatic diabetic individuals at heightened risk for death. Whether CCTA-detected CAD enables improved risk assessment of asymptomatic diabetic individuals beyond clinical risk factors and coronary artery calcium scoring (CACS) remains unexplored.
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performance of the traditional age sex and angina typicality based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary Computed Tomographic Angiography results from the multinational coronary ct Angiography evaluation for clinical outcomes an international multicenter registry confirm
Circulation, 2011Co-Authors: Victor Y Cheng, Stephan Achenbach, Daniel S Berman, Tracy Q Callister, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Alan Rozanski, Allison Dunning, Hyuk Jae ChangAbstract:Background—Guidelines for the management of patients with suspected coronary artery disease (CAD) rely on the age, sex, and angina typicality–based pretest probabilities of angiographically significant CAD derived from invasive coronary Angiography (guideline probabilities). Reliability of guideline probabilities has not been investigated in patients referred to noninvasive CAD testing. Methods and Results—We identified 14048 consecutive patients with suspected CAD who underwent coronary Computed Tomographic Angiography. Angina typicality was recorded with the use of accepted criteria. Pretest likelihoods of CAD with ≥50 diameter stenosis (CAD50) and ≥70 diameter stenosis (CAD70) were calculated from guideline probabilities. Computed Tomographic Angiography images were evaluated by ≥1 expert reader to determine the presence of CAD50 and CAD70. Typical angina was associated with the highest prevalence of CAD50 (40 in men, 19 in women) and CAD70 (27 men, 11 women) compared with other symptom categories (P<0...
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mortality risk in symptomatic patients with nonobstructive coronary artery disease a prospective 2 center study of 2 583 patients undergoing 64 detector row coronary Computed Tomographic Angiography
Journal of the American College of Cardiology, 2011Co-Authors: Fay Y Lin, Jinho Choi, Leslee J Shaw, Jonathan W Weinsaft, Troy M Labounty, Millie Gomez, Allison Dunning, Sunaina Koduru, Augustin Delago, Tracy Q CallisterAbstract:Objectives We examined mortality risk in relation to extent and composition of nonobstructive plaques by 64-detector row coronary Computed Tomographic Angiography (CCTA). Background The prognostic significance of nonobstructive coronary artery plaques by CCTA is poorly understood. Methods We prospectively evaluated consecutive adults from 2 centers undergoing 64-detector row CCTA without prior documented coronary artery disease (CAD) and without obstructive (≥50%) CAD by CCTA. Luminal diameter stenosis severity was classified for each segment as none (0%) or mild (1% to 49%), and plaque composition was classified as noncalcified, calcified, or mixed. Results During 3.1 ± 0.5 years, 54 intermediate-term (≥90 days) deaths occurred among 2,583 patients (2.09%), with 4 early ( Conclusions The presence and extent of nonobstructive plaques augment prediction of incident mortality beyond conventional clinical risk assessment.
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prognosis by coronary Computed Tomographic Angiography matched comparison with myocardial perfusion single photon emission Computed tomography
Journal of Cardiovascular Computed Tomography, 2008Co-Authors: Leslee J Shaw, James K Min, Daniel S Berman, Robert C Hendel, Salvador Borges Neto, Tracy Q CallisterAbstract:Background The diagnostic accuracy of coronary Computed Tomographic Angiography (CTA) is high with few reports noting its ability to stratify risk. The quantity and quality of prognostic evidence with myocardial perfusion single-photon emission Computed tomography (SPECT) (MPS) is diverse, with little comparative evidence between methods. The aim of this report was to compare all-cause death rates for 7 CTA subsets, using the Duke prognostic index, compared with percentage of ischemic myocardium by MPS. Methods We performed a matched cohort comparison of patients with suspected coronary artery disease (CAD) referred for evaluation of new onset chest pain with 693 and 3067 patients undergoing CTA and MPS. The primary endpoint was time to all-cause death estimated with univariable and multivariable (controlling for pretest CAD likelihood and cardiac risk factors) Cox proportional hazards models. Patients undergoing MPS were matched, using a propensity scoring technique, to the CTA cohort, yielding 16%, 60%, and 24% of the patients with low, intermediate, and high pretest CAD likelihood ( P = 0.39). Results Two-year mortality was similar for CTA and MPS at 3.2% ( P = 0.71). For CTA, the Duke prognostic index was independently predictive of death in risk-adjusted models controlling for risk factors and pretest likelihood of CAD ( P P = 0.013) to 85% survival for patients with ≥50% left main stenosis ( P P P P = 0.53). Annual mortality rates ranged from 0.1% to 11.7% by the extent and severity of abnormalities noted on CTA and MPS ( P = 0.53). Conclusion A directly proportional relation was observed between the extent and severity of MPS ischemia and angiographic CAD. High-risk ischemia is more often associated with extensive CAD and high mortality risk. The results from this matched, observational study require additional validation for longer-term predictive models that include major adverse cardiovascular events and diverse patient subsets.
Daniel S Berman - One of the best experts on this subject based on the ideXlab platform.
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performance of the traditional age sex and angina typicality based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary Computed Tomographic Angiography results from the multinational coronary ct Angiography evaluation for clinical outcomes an international multicenter registry confirm
Circulation, 2011Co-Authors: Victor Y Cheng, Stephan Achenbach, Daniel S Berman, Tracy Q Callister, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Alan Rozanski, Allison Dunning, Hyuk Jae ChangAbstract:Background—Guidelines for the management of patients with suspected coronary artery disease (CAD) rely on the age, sex, and angina typicality–based pretest probabilities of angiographically significant CAD derived from invasive coronary Angiography (guideline probabilities). Reliability of guideline probabilities has not been investigated in patients referred to noninvasive CAD testing. Methods and Results—We identified 14048 consecutive patients with suspected CAD who underwent coronary Computed Tomographic Angiography. Angina typicality was recorded with the use of accepted criteria. Pretest likelihoods of CAD with ≥50 diameter stenosis (CAD50) and ≥70 diameter stenosis (CAD70) were calculated from guideline probabilities. Computed Tomographic Angiography images were evaluated by ≥1 expert reader to determine the presence of CAD50 and CAD70. Typical angina was associated with the highest prevalence of CAD50 (40 in men, 19 in women) and CAD70 (27 men, 11 women) compared with other symptom categories (P<0...
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the ct stat coronary Computed Tomographic Angiography for systematic triage of acute chest pain patients to treatment trial
Journal of the American College of Cardiology, 2011Co-Authors: James A Goldstein, Sean W Hayes, Stephan Achenbach, Daniel S Berman, Kavitha Chinnaiyan, Aiden Abidov, Udo Hoffmann, John R Lesser, Issam Mikati, Brian J OneilAbstract:Objectives The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary Computed Tomographic Angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain. Background In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion. Methods This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up. Results The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p Conclusions In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325)
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the ct stat coronary Computed Tomographic Angiography for systematic triage of acute chest pain patients to treatment trial
Journal of the American College of Cardiology, 2011Co-Authors: James A Goldstein, Sean W Hayes, Stephan Achenbach, Daniel S Berman, Kavitha Chinnaiyan, Aiden Abidov, Udo Hoffmann, John R Lesser, Issam Mikati, Brian J OneilAbstract:OBJECTIVES: The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary Computed Tomographic Angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain. BACKGROUND: In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion. METHODS: This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up. RESULTS: The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p < 0.0001). Costs of care were 38% lower compared with standard (median $2,137 [25th to 75th percentile: $1,660 to $3,077] vs. $3,458 [25th to 75th percentile: $2,900 to $4,297], p < 0.0001). The diagnostic strategies had no difference in major adverse cardiac events after normal index testing (0.8% in the CCTA arm vs. 0.4% in the MPI arm, p = 0.29). CONCLUSIONS: In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325).
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rationale and design of the defacto determination of fractional flow reserve by anatomic Computed Tomographic Angiography study
Journal of Cardiovascular Computed Tomography, 2011Co-Authors: Daniel S Berman, Matthew J Budoff, Jonathon Leipsic, Farouc A Jaffer, Martin B Leon, G John B Mancini, Laura Mauri, Robert S Schwartz, Leslee J ShawAbstract:Background Coronary Computed Tomographic Angiography (CTA) allows for noninvasive identification of anatomic coronary artery disease (CAD) severity but does not discriminate whether a stenosis causes ischemia. Computational fluid dynamic techniques applied to CTA images now permit noninvasive computation of fractional flow reserve (FFR), a measure of lesion-specific ischemia, but the diagnostic performance of Computed FFR (FFR CT ) as compared with measured FFR at the time of invasive coronary Angiography remains unexplored. Objective We determined the diagnostic accuracy of noninvasive FFR CT for the detection and exclusion of ischemia-causing stenoses. Methods DeFACTO (NCT01233518) is a prospective, international, multicenter study of 238 patients designed to evaluate the diagnostic performance of FFR CT for the detection of hemodynamically significant coronary artery stenoses identified by CTA, compared with invasive FFR as a reference standard. FFR values ≤ 0.80 will be considered hemodynamically significant. Patients enrolled in the DeFACTO study will undergo CTA, invasive coronary Angiography, and 3-vessel FFR in the left anterior descending artery, left circumflex artery, and right coronary artery distributions. FFR CT will be Computed with acquired CTA images, without modification to CTA image acquisition protocols and without additional image acquisition. Blinded core laboratory interpretation will be performed for CTA, invasive coronary Angiography, FFR, and FFR CT . Results The primary endpoint of the DeFACTO study is the per-patient diagnostic accuracy of FFR CT for noninvasive assessment of the hemodynamic significance of CAD, compared with FFR during invasive coronary Angiography as a reference standard. The secondary endpoints include additional per-patient as well as per-vessel diagnostic performance characteristics, including sensitivity, specificity, positive predictive value, and negative predictive value. Conclusion The DeFACTO study will determine whether the addition of FFR CT to conventional CTA improves the diagnosis of hemodynamically significant CAD.
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prognosis by coronary Computed Tomographic Angiography matched comparison with myocardial perfusion single photon emission Computed tomography
Journal of Cardiovascular Computed Tomography, 2008Co-Authors: Leslee J Shaw, James K Min, Daniel S Berman, Robert C Hendel, Salvador Borges Neto, Tracy Q CallisterAbstract:Background The diagnostic accuracy of coronary Computed Tomographic Angiography (CTA) is high with few reports noting its ability to stratify risk. The quantity and quality of prognostic evidence with myocardial perfusion single-photon emission Computed tomography (SPECT) (MPS) is diverse, with little comparative evidence between methods. The aim of this report was to compare all-cause death rates for 7 CTA subsets, using the Duke prognostic index, compared with percentage of ischemic myocardium by MPS. Methods We performed a matched cohort comparison of patients with suspected coronary artery disease (CAD) referred for evaluation of new onset chest pain with 693 and 3067 patients undergoing CTA and MPS. The primary endpoint was time to all-cause death estimated with univariable and multivariable (controlling for pretest CAD likelihood and cardiac risk factors) Cox proportional hazards models. Patients undergoing MPS were matched, using a propensity scoring technique, to the CTA cohort, yielding 16%, 60%, and 24% of the patients with low, intermediate, and high pretest CAD likelihood ( P = 0.39). Results Two-year mortality was similar for CTA and MPS at 3.2% ( P = 0.71). For CTA, the Duke prognostic index was independently predictive of death in risk-adjusted models controlling for risk factors and pretest likelihood of CAD ( P P = 0.013) to 85% survival for patients with ≥50% left main stenosis ( P P P P = 0.53). Annual mortality rates ranged from 0.1% to 11.7% by the extent and severity of abnormalities noted on CTA and MPS ( P = 0.53). Conclusion A directly proportional relation was observed between the extent and severity of MPS ischemia and angiographic CAD. High-risk ischemia is more often associated with extensive CAD and high mortality risk. The results from this matched, observational study require additional validation for longer-term predictive models that include major adverse cardiovascular events and diverse patient subsets.
Matthew J Budoff - One of the best experts on this subject based on the ideXlab platform.
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natural history of diabetic coronary atherosclerosis by quantitative measurement of serial coronary Computed Tomographic Angiography results of the paradigm study progression of atherosclerotic plaque determined by Computed Tomographic Angiography imaging
Jacc-cardiovascular Imaging, 2018Co-Authors: Jonathon Leipsic, Matthew J Budoff, Martin Hadamitzky, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Stephanie L Sellers, Michael Shao, Philipp Blanke, Ilan GottliebAbstract:Abstract Objectives This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). Background The natural history of coronary PP in patients with DM is not well established. Methods A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary Computed tomography Angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary Computed tomography Angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0. Results DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤ 0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (−7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. Conclusions People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.
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relationship of hypertension to coronary atherosclerosis and cardiac events in patients with coronary Computed Tomographic Angiography
Hypertension, 2017Co-Authors: Rine Nakanishi, Heidi Gransar, Stephan Achenbach, Tracy Q Callister, Lohendran Baskaran, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Hyuk Jae Chang, Kavitha ChinnaiyanAbstract:Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary Computed Tomographic Angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary Computed Tomographic Angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events.
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rationale and design of the progression of atherosclerotic plaque determined by Computed Tomographic Angiography imaging paradigm registry a comprehensive exploration of plaque progression and its impact on clinical outcomes from a multicenter serial coronary Computed Tomographic Angiography study
American Heart Journal, 2016Co-Authors: Sang Eun Lee, Hyuk Jae Chang, Asim Rizvi, Martin Hadamitzky, Yong Jin Kim, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Valentina Volpato, Matthew J BudoffAbstract:Background The natural history of coronary artery disease (CAD) in patients with low-to-intermediate risk is not well characterized. Although earlier invasive serial studies have documented the progression of atherosclerotic burden, most were focused on high-risk patients only. The PARADIGM registry is a large, prospective, multinational dynamic observational registry of patients undergoing serial coronary Computed Tomographic Angiography (CCTA). The primary aim of PARADIGM is to characterize the natural history of CAD in relation to clinical and laboratory data. Design The PARADIGM registry ( ClinicalTrials.gov NCT02803411 ) comprises ≥2,000 consecutive patients across 9 cluster sites in 7 countries. PARADIGM sites were chosen on the basis of adequate CCTA volume, site CCTA proficiency, local demographic characteristics, and medical facilities to ensure a broad-based sample of patients. Patients referred for clinically indicated CCTA will be followed up and enrolled if they had a second CCTA scan. Patients will also be followed up beyond serial CCTA performance to identify adverse CAD events that include cardiac and noncardiac death, myocardial infarction, unstable angina, target vessel revascularization, and CAD-related hospitalization. Summary The results derived from the PARADIGM registry are anticipated to add incremental insight into the changes in CCTA findings in accordance with the progression or regression of CAD that confer prognostic value beyond demographic and clinical characteristics.
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incremental prognostic value of coronary Computed Tomographic Angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals
Atherosclerosis, 2014Co-Authors: James K Min, Stephan Achenbach, Tracy Q Callister, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Hyuk Jae Chang, Troy M Labounty, Millie Gomez, Victor Y ChengAbstract:Background Coronary artery disease (CAD) diagnosis by coronary Computed Tomographic Angiography (CCTA) is useful for identification of symptomatic diabetic individuals at heightened risk for death. Whether CCTA-detected CAD enables improved risk assessment of asymptomatic diabetic individuals beyond clinical risk factors and coronary artery calcium scoring (CACS) remains unexplored.
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performance of the traditional age sex and angina typicality based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary Computed Tomographic Angiography results from the multinational coronary ct Angiography evaluation for clinical outcomes an international multicenter registry confirm
Circulation, 2011Co-Authors: Victor Y Cheng, Stephan Achenbach, Daniel S Berman, Tracy Q Callister, Matthew J Budoff, Mouaz Almallah, Filippo Cademartiri, Alan Rozanski, Allison Dunning, Hyuk Jae ChangAbstract:Background—Guidelines for the management of patients with suspected coronary artery disease (CAD) rely on the age, sex, and angina typicality–based pretest probabilities of angiographically significant CAD derived from invasive coronary Angiography (guideline probabilities). Reliability of guideline probabilities has not been investigated in patients referred to noninvasive CAD testing. Methods and Results—We identified 14048 consecutive patients with suspected CAD who underwent coronary Computed Tomographic Angiography. Angina typicality was recorded with the use of accepted criteria. Pretest likelihoods of CAD with ≥50 diameter stenosis (CAD50) and ≥70 diameter stenosis (CAD70) were calculated from guideline probabilities. Computed Tomographic Angiography images were evaluated by ≥1 expert reader to determine the presence of CAD50 and CAD70. Typical angina was associated with the highest prevalence of CAD50 (40 in men, 19 in women) and CAD70 (27 men, 11 women) compared with other symptom categories (P<0...
Sean W Hayes - One of the best experts on this subject based on the ideXlab platform.
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the ct stat coronary Computed Tomographic Angiography for systematic triage of acute chest pain patients to treatment trial
Journal of the American College of Cardiology, 2011Co-Authors: James A Goldstein, Sean W Hayes, Stephan Achenbach, Daniel S Berman, Kavitha Chinnaiyan, Aiden Abidov, Udo Hoffmann, John R Lesser, Issam Mikati, Brian J OneilAbstract:OBJECTIVES: The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary Computed Tomographic Angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain. BACKGROUND: In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion. METHODS: This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up. RESULTS: The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p < 0.0001). Costs of care were 38% lower compared with standard (median $2,137 [25th to 75th percentile: $1,660 to $3,077] vs. $3,458 [25th to 75th percentile: $2,900 to $4,297], p < 0.0001). The diagnostic strategies had no difference in major adverse cardiac events after normal index testing (0.8% in the CCTA arm vs. 0.4% in the MPI arm, p = 0.29). CONCLUSIONS: In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325).
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the ct stat coronary Computed Tomographic Angiography for systematic triage of acute chest pain patients to treatment trial
Journal of the American College of Cardiology, 2011Co-Authors: James A Goldstein, Sean W Hayes, Stephan Achenbach, Daniel S Berman, Kavitha Chinnaiyan, Aiden Abidov, Udo Hoffmann, John R Lesser, Issam Mikati, Brian J OneilAbstract:Objectives The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary Computed Tomographic Angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain. Background In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion. Methods This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up. Results The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p Conclusions In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325)
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moving beyond binary grading of coronary arterial stenoses on coronary Computed Tomographic Angiography insights for the imager and referring clinician
Jacc-cardiovascular Imaging, 2008Co-Authors: Victor Y Cheng, Ariel Gutstein, Arik Wolak, Yasuyuki Suzuki, Damini Dey, Heidi Gransar, Louise E J Thomson, Sean W HayesAbstract:Moving Beyond Binary Grading of Coronary Arterial Stenoses on Coronary Computed Tomographic Angiography: Insights for the Imager and Referring ClinicianVictor Cheng, Ariel Gutstein, Arik Wolak, Yas...
