Cargando…

Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

BACKGROUND: Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no...

Descripción completa

Detalles Bibliográficos
Autores principales: Lin, Charles K, McDonough, Ryan J, Prentice, Ryan L, Thomas, Dustin M, Steel, Kevin E, Rubal, Bernard J, Shry, Eric A, Villines, Todd C, Hulten, Edward A, Slim, Ahmad M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607186/
https://www.ncbi.nlm.nih.gov/pubmed/26770728
http://dx.doi.org/10.1177/2050312114533535
_version_ 1782395474771181568
author Lin, Charles K
McDonough, Ryan J
Prentice, Ryan L
Thomas, Dustin M
Steel, Kevin E
Rubal, Bernard J
Shry, Eric A
Villines, Todd C
Hulten, Edward A
Slim, Ahmad M
author_facet Lin, Charles K
McDonough, Ryan J
Prentice, Ryan L
Thomas, Dustin M
Steel, Kevin E
Rubal, Bernard J
Shry, Eric A
Villines, Todd C
Hulten, Edward A
Slim, Ahmad M
author_sort Lin, Charles K
collection PubMed
description BACKGROUND: Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center. METHODS: We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis), non-obstructive (<50% stenosis), and no coronary artery disease (no angiographic disease). Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization) were obtained. RESULTS: Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13–34 months), the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001). The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001). CONCLUSION: Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was associated with a significantly increased incidence of ischemic stroke. There was also a direct correlation between the severity of coronary artery disease on CCTA and cardiovascular prognosis over the follow-up period of 24 months.
format Online
Article
Text
id pubmed-4607186
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-46071862016-01-14 Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center Lin, Charles K McDonough, Ryan J Prentice, Ryan L Thomas, Dustin M Steel, Kevin E Rubal, Bernard J Shry, Eric A Villines, Todd C Hulten, Edward A Slim, Ahmad M SAGE Open Med Original Article BACKGROUND: Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center. METHODS: We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis), non-obstructive (<50% stenosis), and no coronary artery disease (no angiographic disease). Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization) were obtained. RESULTS: Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13–34 months), the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001). The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001). CONCLUSION: Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was associated with a significantly increased incidence of ischemic stroke. There was also a direct correlation between the severity of coronary artery disease on CCTA and cardiovascular prognosis over the follow-up period of 24 months. SAGE Publications 2014-05-02 /pmc/articles/PMC4607186/ /pubmed/26770728 http://dx.doi.org/10.1177/2050312114533535 Text en © The Author(s) 2014 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(http://www.uk.sagepub.com/aboutus/openaccess.htm).
spellingShingle Original Article
Lin, Charles K
McDonough, Ryan J
Prentice, Ryan L
Thomas, Dustin M
Steel, Kevin E
Rubal, Bernard J
Shry, Eric A
Villines, Todd C
Hulten, Edward A
Slim, Ahmad M
Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center
title Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center
title_full Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center
title_fullStr Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center
title_full_unstemmed Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center
title_short Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center
title_sort assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607186/
https://www.ncbi.nlm.nih.gov/pubmed/26770728
http://dx.doi.org/10.1177/2050312114533535
work_keys_str_mv AT lincharlesk assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT mcdonoughryanj assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT prenticeryanl assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT thomasdustinm assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT steelkevine assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT rubalbernardj assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT shryerica assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT villinestoddc assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT hultenedwarda assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter
AT slimahmadm assessmentofmajoradversecardiovasculareventsandischemicstrokewithcoronarycomputedtomographyangiographybaseduponangiographicdiagnosisinahighvolumesinglecenter