Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography

A systematic review and meta-analysis

Phillip J. Habib, Jacinta Green, Ryan C. Butterfield, Gretchen M. Kuntz, Raguveer Murthy, Dale Kraemer, Robert F. Percy, Alan B. Miller, Joel A. Strom

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background The value of ≥ 64-slice coronary CT angiography (CCTA) to determine odds of cardiac death or non-fatal myocardial infarction (MI) needs further clarification. Methods We performed a systematic review and meta-analysis using publications reporting events/severity of coronary artery disease (CAD) in patients with suspected CAD undergoing CCTA. Patients were divided into: no CAD, non-obstructive CAD (maximal stenosis < 50%), and obstructive CAD (≥ 50% stenosis). Odds ratios with 95% confidence intervals were calculated using a fixed or random effects model. Heterogeneity was assessed using the I2 index. Results We included thirty-two studies comprising 41,960 patients with 363 all-cause deaths (15.0%), 114 cardiac deaths (4.7%), 342 MI (14.2%), 69 unstable angina (2.8%), and 1527 late revascularizations (63.2%) over 1.96 (SD 0.77) years of follow-up. Cardiac death or MI occurred in 0.04% without, 1.29% with non-obstructive, and 6.53% with obstructive CAD. OR for cardiac death or MI was: 14.92 (95% CI, 6.78 to 32.85) for obstructive CAD, 6.41 (95% CI, 2.44 to 16.84) for non-obstructive CAD versus no CAD, and 3.19 (95% CI, 2.29 to 4.45) for non-obstructive versus obstructive CAD and 6.56 (95% CI, 3.07 to 14.02) for no versus any CAD. Similar trends were noted for all-cause mortality and composite major adverse cardiovascular events. Conclusions Increasing CAD severity detected by CCTA is associated with cardiac death or MI, all-cause mortality, and composite major adverse cardiovascular events. Absence of CAD is associated with very low odds of major adverse events, but non-obstructive disease significantly increases odds of cardiac adverse events in this follow-up period.

Original languageEnglish (US)
Pages (from-to)112-120
Number of pages9
JournalInternational Journal of Cardiology
Volume169
Issue number2
DOIs
StatePublished - Oct 30 2013
Externally publishedYes

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Coronary Angiography
Meta-Analysis
Coronary Artery Disease
Myocardial Infarction
Computed Tomography Angiography
Pathologic Constriction
Mortality
Unstable Angina
Publications
Cause of Death
Odds Ratio
Confidence Intervals

Keywords

  • Cardiovascular events
  • Coronary artery disease
  • Coronary CT angiography
  • Meta-analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography : A systematic review and meta-analysis. / Habib, Phillip J.; Green, Jacinta; Butterfield, Ryan C.; Kuntz, Gretchen M.; Murthy, Raguveer; Kraemer, Dale; Percy, Robert F.; Miller, Alan B.; Strom, Joel A.

In: International Journal of Cardiology, Vol. 169, No. 2, 30.10.2013, p. 112-120.

Research output: Contribution to journalArticle

Habib, Phillip J. ; Green, Jacinta ; Butterfield, Ryan C. ; Kuntz, Gretchen M. ; Murthy, Raguveer ; Kraemer, Dale ; Percy, Robert F. ; Miller, Alan B. ; Strom, Joel A. / Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography : A systematic review and meta-analysis. In: International Journal of Cardiology. 2013 ; Vol. 169, No. 2. pp. 112-120.
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T2 - A systematic review and meta-analysis

AU - Habib, Phillip J.

AU - Green, Jacinta

AU - Butterfield, Ryan C.

AU - Kuntz, Gretchen M.

AU - Murthy, Raguveer

AU - Kraemer, Dale

AU - Percy, Robert F.

AU - Miller, Alan B.

AU - Strom, Joel A.

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N2 - Background The value of ≥ 64-slice coronary CT angiography (CCTA) to determine odds of cardiac death or non-fatal myocardial infarction (MI) needs further clarification. Methods We performed a systematic review and meta-analysis using publications reporting events/severity of coronary artery disease (CAD) in patients with suspected CAD undergoing CCTA. Patients were divided into: no CAD, non-obstructive CAD (maximal stenosis < 50%), and obstructive CAD (≥ 50% stenosis). Odds ratios with 95% confidence intervals were calculated using a fixed or random effects model. Heterogeneity was assessed using the I2 index. Results We included thirty-two studies comprising 41,960 patients with 363 all-cause deaths (15.0%), 114 cardiac deaths (4.7%), 342 MI (14.2%), 69 unstable angina (2.8%), and 1527 late revascularizations (63.2%) over 1.96 (SD 0.77) years of follow-up. Cardiac death or MI occurred in 0.04% without, 1.29% with non-obstructive, and 6.53% with obstructive CAD. OR for cardiac death or MI was: 14.92 (95% CI, 6.78 to 32.85) for obstructive CAD, 6.41 (95% CI, 2.44 to 16.84) for non-obstructive CAD versus no CAD, and 3.19 (95% CI, 2.29 to 4.45) for non-obstructive versus obstructive CAD and 6.56 (95% CI, 3.07 to 14.02) for no versus any CAD. Similar trends were noted for all-cause mortality and composite major adverse cardiovascular events. Conclusions Increasing CAD severity detected by CCTA is associated with cardiac death or MI, all-cause mortality, and composite major adverse cardiovascular events. Absence of CAD is associated with very low odds of major adverse events, but non-obstructive disease significantly increases odds of cardiac adverse events in this follow-up period.

AB - Background The value of ≥ 64-slice coronary CT angiography (CCTA) to determine odds of cardiac death or non-fatal myocardial infarction (MI) needs further clarification. Methods We performed a systematic review and meta-analysis using publications reporting events/severity of coronary artery disease (CAD) in patients with suspected CAD undergoing CCTA. Patients were divided into: no CAD, non-obstructive CAD (maximal stenosis < 50%), and obstructive CAD (≥ 50% stenosis). Odds ratios with 95% confidence intervals were calculated using a fixed or random effects model. Heterogeneity was assessed using the I2 index. Results We included thirty-two studies comprising 41,960 patients with 363 all-cause deaths (15.0%), 114 cardiac deaths (4.7%), 342 MI (14.2%), 69 unstable angina (2.8%), and 1527 late revascularizations (63.2%) over 1.96 (SD 0.77) years of follow-up. Cardiac death or MI occurred in 0.04% without, 1.29% with non-obstructive, and 6.53% with obstructive CAD. OR for cardiac death or MI was: 14.92 (95% CI, 6.78 to 32.85) for obstructive CAD, 6.41 (95% CI, 2.44 to 16.84) for non-obstructive CAD versus no CAD, and 3.19 (95% CI, 2.29 to 4.45) for non-obstructive versus obstructive CAD and 6.56 (95% CI, 3.07 to 14.02) for no versus any CAD. Similar trends were noted for all-cause mortality and composite major adverse cardiovascular events. Conclusions Increasing CAD severity detected by CCTA is associated with cardiac death or MI, all-cause mortality, and composite major adverse cardiovascular events. Absence of CAD is associated with very low odds of major adverse events, but non-obstructive disease significantly increases odds of cardiac adverse events in this follow-up period.

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KW - Coronary artery disease

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KW - Meta-analysis

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