ABSTRACT
PURPOSE: Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not. MATERIALS AND METHODS: This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (−) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses. RESULTS: During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (−) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (−) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172–8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (−) group seemed to also have a higher risk of recurrent stroke. CONCLUSION: Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.
Subject(s)
Female , Humans , Male , Asymptomatic Diseases , Coronary Artery Disease/diagnostic imaging , Follow-Up Studies , Multidetector Computed Tomography/statistics & numerical data , Propensity Score , Proportional Hazards Models , Prospective Studies , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors , Stroke/complicationsABSTRACT
Introdução: A extensão da doença arterial coronariana (DAC) é um dos mais fortes preditores de eventos cardiovasculares adversos. Estratégias capazes de quantificar acuradamente a gravidade da doença coronária podem implicar em melhora na avalição prognóstica, na orientação terapêutica e na avaliação da progressão da doença. O ultrassom intracoronário (USIC) tornou-se o método padrão-ouro para quantificação da aterosclerose devido à sua habilidade em avaliar diretamente as placas ateroscleróticas. A angiotomografia coronária tem surgido como uma útil alternativa não invasiva ao USIC para avaliação de pacientes com DAC. Entretanto, pouco se sabe a respeito da sua habilidade em estimar, de modo acurado, a carga aterosclerótica coronariana global. Objetivo: Comparar diversos escores angiotomográficos que avaliam a extensão da DAC utilizando o USIC multivascular como padrão-ouro. Métodos: Pacientes com doença coronariana diagnosticada, em programação para intervenção percutânea foram incluídos prospectivamente. Pelo menos uma de três características de alto risco era necessária para inclusão: doença multiarterial, diabetes melitus e/ou síndrome coronária aguda à admissão. Todos os pacientes foram submetidos a ultrassom intracoronário multivascular e angiotomografia coronária. Escore de cálcio e cinco outros escores previamente descritos foram calculados com base na imagem da angiotomografia coronária e comparados com o volume percentual de ateroma (VPA) médio derivado do USIC. Um novo escore angiotomográfico foi criado e também comparado ao USIC. Resultados: Um total de 62 pacientes foram incluídos. Todos com exceção de um escore apresentaram baixa a moderada correlação, estatisticamente significante, com o VPA derivado do USIC. O novo escore angiotomográfico criado demonstrou a mais forte correlação com o VPA ao USIC (ρ=0,73, p < 0,001) e a maior área sob a curva ROC (estatística-C = 0,90) para predizer um VPA médio dicotomizado alto. Conclusões: Enquanto...
Background: The extent of coronary artery disease (CAD) is one the most powerful predictors of cardiovascular outcomes. Strategies that accurately quantify coronary artery disease severity are expected to improve prognosis assessment, treatment guidance and evaluation of disease progression. Intravascular ultrasound (IVUS) has become the gold-standard method to quantify atherosclerosis due to its ability to directly analyze atherosclerotic plaques. Coronary computed tomography angiography (CTA) has emerged as a useful non-invasive alternative to IVUS for assessing patients with CAD. Nevertheless, little is known about its ability to accurately estimate global atherosclerotic burden. Objective: To compare several coronary CTA scoring systems assessing CAD extent with gold-standard multivessel intravascular ultrasound. Methods: Patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 5 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). A novel coronary CTA score was constructed and also compared to IVUS. Results: A total of 62 patients were included. All but one previously described scoring system showed a significant low-to-moderate association with IVUS-derived PAV. The newly developed "soft plaque" coronary CTA score demonstrated the strongest correlation with IVUS-PAV (ρ=0.73, p<0.001) and the greatest area under the ROC curve (C-statistic = 0.90) to predict a high dichotomized PAV. Conclusions: While coronary CTA scores were able to assess total atherosclerotic burden in patients with coronary disease, a newly described CTA scoring system may be a promising non-invasive tool to quantify disease extent in high-risk patients with known CAD.
Subject(s)
Humans , Male , Atherosclerosis , Coronary Artery Disease , Image Processing, Computer-Assisted , Plaque, Atherosclerotic , Multidetector Computed Tomography/statistics & numerical data , Multidetector Computed Tomography , Ultrasonography, Interventional , Coronary VesselsABSTRACT
To investigate the accuracy of 64-row MDCT to analyze and quantify coronary arterial plaques in patients presented with acute coronary syndrome [ACS]. Between April 2010 and December 2013, 50 patients presented with acute cardiac chest pain were categorized into 2 groups according to their diagnosis based on clinical evaluation, ECG findings and cardiac biomarkers; group A including patients with ACS and group B including patients with stable angina [SA]. Both groups underwent 64-row multidetector CT [MDCT] coronary arterial imaging. For each plaque, stenosis percentage was evaluated and the plaque was quantified using software [Sureplaque[registered]] based on the density [HU] and percentage of its individual components including lipid, soft tissue, and calcium density. Of the 50 patients; 24 and 26 were grouped into groups A and B respectively. The mean value of stenosis percent of the proximal and middle coronary segments of group A patients = 77.2% +/- 10.2% - 90.5% +/- 58.4% and 79.5% +/- 9.1% - 85.25% +/- 11% respectively, while in group B = 54.1% +/- 12.1% - 65.2% +/- 18.4% and 53.3% +/- 1.5% - 68.6% +/- 11.7% respectively [p=0.00-0.001]. Quantification showed a mean value of lipid content percentage of group A = 15.4% +/- 0.8% - 47.7% +/- 19.2%, while in group B = 7.2% +/- 5.5% - 10.3% +/- 8.2% [p=0.008-0.001]. The mean value of soft tissue content percentage in group A = 15.4% +/- 0.8% - 47.7% +/- 19.2%, while in group B = 7.2% +/- 5.5% - 10.3% +/- 8.2%. The calcification content percentage in group A = 18% +/- 8.7% - 35.1% +/- 16%, while in group B = 66.4% +/- 13.8% - 76.7% +/- 16.5%. 64-row MDCT angiographic quantification software provides a good basis for the future attempts of proper risk stratification of patients with coronary artery disease especially those liable for developing ACS