Coronary CT Follow-up Study Of Acute Coronary Events

OBJECTIVES:To evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) for Major Adverse Cardiac Events (MACE).METHODS:We followed5007outpatients who were suspected of coronary artery disease (CAD) and underwent cardiac computed tomography (CT). Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in CCTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction (MI), or coronary revascularization. Then, we chose463outpatients who were suspected of CAD and underwent cCTA. They were all under45years old. The endpoint was also MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization, to document the prevalence of coronary artery disease CAD and MACE in patients less than45years of age, and to determine whether CCTA is useful for risk stratification of this cohort.RESULTS:Follow-up was completed in4425patients (88.4%) with a median follow-up period of1081days. At the end of the follow-up period,363(8.2%) patients experienced MACE. Cumulative probability of3-year MACE increased across CT strata for CACS (CACS=0,2.1%; CACS1-100,12.9%; CACS101-400,16.3%; CACS>400,33.8%; log-rank p<0.001), CCTA (No plaque,0.8%; Non obstructive disease,3.7%;1-vessel disease,27.6%;2-vessels disease,35.5%;3-vessels disease,57.7%, log-rank p<0.001) and characteristics of the plaques (5.5%for calcified plaque,22.7%for non-calcified plaque,37.7%for mixed plaque; log-rank p<0.001). The area under the receiver-operator characteristic (ROC) curves showing the incremental value of CACS and CCTA for predicting MACE (0.71for clinical risk factors and improved to0.82by adding CACS and improved further to0.93by adding CCTA, both p<0.001). For the young adults, follow-up was completed in427patients (94.5%) with a median follow-up period of1081days. No plaque was noted in357(83.6%) patients. Non-significant CAD was noted in33(7.7%) individuals and37(8.7%) patients with significant CAD. At the end of the follow-up period,12(2.8%) patients experienced MACE. The annualized event rate was0.2%in patients with no plaque,2.0%in patients with non-significant CAD and7.3%in patients with significant CAD. CCTA was a predictor (p<0.001) of events after multivariate correction (hazard ratio:8.345,95%CI:3.438-17.823, p<0.001).CONCLUSIONS:CACS and CCTA findings have prognostic value and have incremental value over routine risk factors for MACE and CCTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value. Rationale and Objectives:To document the prevalence of coronary artery disease (CAD) and major adverse cardiac events (MACE) in patients under45years of age with intermediate pretest likelihood of CAD, and to determine whether coronary CT angiography (cCTA) is useful for risk stratification of this cohort.Materials and Methods:We followed452intermediate pretest likelihood (according to Diamond and Forrester) outpatients who were suspected of CAD and underwent cCTA. They were all under45years old. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization.Results:Follow-up was completed in427patients (94.5%) with a median follow-up period of1081days. No plaque was noted in357(83.6%) patients. Non-significant CAD was noted in33(7.7%) individuals and37(8.7%) patients with significant CAD. At the end of the follow-up period,12(2.8%) patients experienced MACE. The annualized event rate was0.2%in patients with no plaque,2.0%in patients with non-significant CAD and7.3%in patients with significant CAD. Hypertension, smoking and significant CAD in cCTA were significant predictors of MACE in univariate analysis. Moreover, cCTA remained a predictor (p<0.001) of events after multivariate correction (hazard ratio:8.345,95%CI:3.438-17.823, p<0.001).Conclusion:The prevalence of CAD and MACE in young adults with an intermediate pretest likelihood of CAD was considerable. cCTA is effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasize the usefulness of cCTA in this cohort. Objectives:To document the prevalence of coronary artery disease (CAD) and major adverse cardiac events (MACE) in intermediate pretest likelihood patients with zero coronary calcium score, and to determine whether coronary CT angiography (CTA) is useful for risk stratification of this cohort.Methods:We followed1479intermediate pretest likelihood patients who were suspected of CAD and underwent cardiac CT. They all with zero coronary artery calcium score (CACS). The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization.Results:Follow-up was completed in1397patients (95.5%) with a median follow-up period of1081days. Non-significant CAD was noted in102(7.3%) individuals and101(7.2%) patients with significant CAD. At the end of the follow-up period,47(3.4%) patients experienced MACE. The annualized event rate was0.3%in patients with no plaque,2.3%in patients with non-significant CAD and10.0%in patients with significant CAD. Age, smoking and significant CAD in CTA were significant predictors of MACE in univariate analysis. Moreover, Significant CAD remained a predictor (p<0.001) of events after multivariate correction (hazard ratio:4.021,95%CI:3.986-6.740, p<0.001).Conclusions:The prevalence of CAD and MACE in intermediate pretest likelihood patients with zero coronary calcium score was considerable. CTA is effective in re-stratifying patients into either a low or high post-test risk group. These results further emphasize the usefulness of CTA in this cohort. Rationale and Objectives:We aimed to evaluate whether matrix metalloproteinase-9(MMP-9) and myeloperoxidase (MPO) are elevated in patients with nonobstructive coronary artery disease.Materials and Methods:Eighty-four patients who had nonobstructive coronary artery disease (group A) and ninety patients who had no coronary plaque (group B) were enrolled. The levels of the biomarkers were compared between the two groups. The relationship between these biomarkers and Framingham risk scores (FRS) were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the ability of these biomarkers to predict the presence of coronary artery plaques.Results:The MMP-9and MPO values in group A were significantly higher than in group B (p<0.001). The levels of MMP-9and MPO showed significant correlation with FRS (r=0.796, p<0.001; and r=0.409, p<0.001). The areas under the ROC curves of MMP-9and MPO were0.80(95%CI:0.74-0.87) and0.74(95%CI:0.66-0.81), respectively.Conclusion:The levels of MMP-9and MPO positively correlated with FRS. Additionally, in patients with nonobstructive coronary artery disease, elevated levels of MMP-9and MPO may identify patients at risk of future myocardial infarction or sudden cardiac death.