Long-term risk of cardiovascular events after detecting silent coronary atheromatosis using computed tomography.

BACKGROUND: Coronary calcium score (CCS) and coronary computed tomography angiography (CTA) assessments using multidetector computed tomography are invaluable for atheromatosis screening. We studied their usefulness in cardiovascular risk assessments, and compared evaluations using the Systematic COronary Risk Evaluation (SCORE) algorithm with those from CTA and CSS assessments in terms of their ability to predict cardiovascular events in Mediterranean patients. PATIENTS AND METHODS: Two hundred and sixty-six asymptomatic patients whose mean age was 55.4 years, 89.5% of whom were men, were evaluated using CTA and CCS and followed for more than 10 years. The CTA and CCS risk predictions were compared with those determined using the SCORE algorithm designed for low-risk populations. RESULTS: Coronary lesions were present in 140 (53.4%) patients. Of the lesions, 17% were noncalcified, 17% were mixed, and 66% were calcified; in addition, 24.2% of the patients who had lesions had cardiovascular events during follow-up (P<0.00001), but just 2.9% of the patients without lesions. Detection of atheromatosis using computed tomography was associated with an increased risk of cardiovascular disease events at more than 10 years [odds ratio (OR): 6.828; 95% confidence interval (CI): 2.001-23.305; P=0.002]. This OR was higher than that obtained for intermediate-risk individuals (OR: 4.818; 95% CI: 1.360-17.075; P=0.015) and lower than that determined for high-risk individuals (OR: 9.395; 95% CI: 2.489-35.460; P=0.001) using the SCORE algorithm, and higher that that determined for CCS assessments (OR: 3.916; 95% CI: 1.572-9.751; P=0.03). More cardiovascular events were associated with higher amounts of calcium. CONCLUSION: The detection of atheromatosis using the CCS and CTA was associated with an increased risk of cardiovascular events at more than 10 years. CTA and CCS assessments had a higher OR than that associated with assessments of patients at intermediate risk using the SCORE algorithm.

Detection of silent coronary artery disease by computed tomographic scan: coronary artery calcium versus noninvasive coronary angiography.

OBJECTIVES: Multislice computerized tomographic scan can identify coronary artery disease (CAD) with quantification of coronary artery calcium (CAC) and computed tomographic coronary angiography (CTA). The utility of CAC in comparison with CTA in asymptomatic patients has not been assessed. METHODS: Patients with risk factors for CAD, who were referred for screening, were studied using CAC and CTA, using a Phillips Mx8000 IDT 16 multislice computed tomographic scanner. RESULTS: Three hundred and forty-seven patients with a mean age of 55 years, 89.9% male, were included. CAC showed calcium deposits in 171 patients (49.3%) whereas CTA found lesions in 157 patients (45%). CAC correctly identified 309 patients with respect to CTA (presence of any disease) implying a test accuracy of 89%, sensitivity of 85%, specificity of 86%, and negative predictive value of 93%. Obstructive lesions were shown by 7.7% of the patients (stenosis >50%), 22% of the patients with CAC greater than 400, and 2.8% of the patients with CAC of 0. To undergo a CTA scan after CAC permits to re-classify 11% of the patients on the basis of CTA. CONCLUSION: CAC, in detecting silent CAD, seems to be a good alternative to CTA, in these asymptomatic patients, but CAC is inappropriate to predict the presence or absence of a coronary artery obstruction.

Trombosis venosa cerebral cortical aislada / Isolated cerebral cortical vein thrombosis

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