Prognostic Value of Cardiac Computed Tomography Angiography: A Systematic Review and Meta-Analysis
The purpose of this study was to systematically review and perform a meta-analysis of the ability of cardiac computed tomography angiography (CCTA) to predict future cardiovascular events and death. The diagnostic accuracy of CCTA is well reported. The prognostic value of CCTA has been described in...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2011-03, Vol.57 (10), p.1237-1247 |
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| creator | HULTEN, Edward A CARBONARO, Salvatore PETRILLO, Sara P MITCHELL, Joshua D VILLINES, Todd C |
| description | The purpose of this study was to systematically review and perform a meta-analysis of the ability of cardiac computed tomography angiography (CCTA) to predict future cardiovascular events and death.
The diagnostic accuracy of CCTA is well reported. The prognostic value of CCTA has been described in several studies, but many were underpowered. Pooling outcomes increases the power to predict rare events.
We searched multiple databases for longitudinal studies of CCTA with at least 3 months follow-up of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), consisting of death, myocardial infarction (MI), and revascularization. Annualized event rates were pooled using a bivariate mixed-effects binomial regression model to calculate summary likelihood ratios and receiver-operating characteristic curves.
Eighteen studies evaluated 9,592 patients with a median follow-up of 20 months. The pooled annualized event rate for obstructive (any vessel with >50% luminal stenosis) versus normal CCTA was 8.8% versus 0.17% per year for MACE (p < 0.05) and 3.2% versus 0.15% for death or MI (p < 0.05). The pooled negative likelihood ratio for MACE after normal CCTA findings was 0.008 (95% confidence interval [CI]: 0.0004 to 0.17, p < 0.001), the positive likelihood ratio was 1.70 (95% CI: 1.42 to 2.02, p < 0.001), sensitivity was 0.99 (95% CI: 0.93 to 1.00, p < 0.001), and specificity was 0.41 (95% CI: 0.31 to 0.52, p < 0.001). Stratifying by no CAD, nonobstructive CAD (worst stenosis |
| doi_str_mv | 10.1016/j.jacc.2010.10.011 |
| format | Article |
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The diagnostic accuracy of CCTA is well reported. The prognostic value of CCTA has been described in several studies, but many were underpowered. Pooling outcomes increases the power to predict rare events.
We searched multiple databases for longitudinal studies of CCTA with at least 3 months follow-up of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), consisting of death, myocardial infarction (MI), and revascularization. Annualized event rates were pooled using a bivariate mixed-effects binomial regression model to calculate summary likelihood ratios and receiver-operating characteristic curves.
Eighteen studies evaluated 9,592 patients with a median follow-up of 20 months. The pooled annualized event rate for obstructive (any vessel with >50% luminal stenosis) versus normal CCTA was 8.8% versus 0.17% per year for MACE (p < 0.05) and 3.2% versus 0.15% for death or MI (p < 0.05). The pooled negative likelihood ratio for MACE after normal CCTA findings was 0.008 (95% confidence interval [CI]: 0.0004 to 0.17, p < 0.001), the positive likelihood ratio was 1.70 (95% CI: 1.42 to 2.02, p < 0.001), sensitivity was 0.99 (95% CI: 0.93 to 1.00, p < 0.001), and specificity was 0.41 (95% CI: 0.31 to 0.52, p < 0.001). Stratifying by no CAD, nonobstructive CAD (worst stenosis <50%), or obstructive CAD, there were incrementally increasing adverse events.
Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.]]></description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2010.10.011</identifier><identifier>PMID: 21145688</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier</publisher><subject>Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular system ; Clinical outcomes ; Coronary Angiography - methods ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - mortality ; Coronary Stenosis - diagnostic imaging ; Coronary vessels ; Drug therapy ; Heart attacks ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Medical sciences ; Mortality ; Myocardial Ischemia - mortality ; Myocardial Revascularization ; Prognosis ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed</subject><ispartof>Journal of the American College of Cardiology, 2011-03, Vol.57 (10), p.1237-1247</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 8, 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23961775$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21145688$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HULTEN, Edward A</creatorcontrib><creatorcontrib>CARBONARO, Salvatore</creatorcontrib><creatorcontrib>PETRILLO, Sara P</creatorcontrib><creatorcontrib>MITCHELL, Joshua D</creatorcontrib><creatorcontrib>VILLINES, Todd C</creatorcontrib><title>Prognostic Value of Cardiac Computed Tomography Angiography: A Systematic Review and Meta-Analysis</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description><![CDATA[The purpose of this study was to systematically review and perform a meta-analysis of the ability of cardiac computed tomography angiography (CCTA) to predict future cardiovascular events and death.
The diagnostic accuracy of CCTA is well reported. The prognostic value of CCTA has been described in several studies, but many were underpowered. Pooling outcomes increases the power to predict rare events.
We searched multiple databases for longitudinal studies of CCTA with at least 3 months follow-up of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), consisting of death, myocardial infarction (MI), and revascularization. Annualized event rates were pooled using a bivariate mixed-effects binomial regression model to calculate summary likelihood ratios and receiver-operating characteristic curves.
Eighteen studies evaluated 9,592 patients with a median follow-up of 20 months. The pooled annualized event rate for obstructive (any vessel with >50% luminal stenosis) versus normal CCTA was 8.8% versus 0.17% per year for MACE (p < 0.05) and 3.2% versus 0.15% for death or MI (p < 0.05). The pooled negative likelihood ratio for MACE after normal CCTA findings was 0.008 (95% confidence interval [CI]: 0.0004 to 0.17, p < 0.001), the positive likelihood ratio was 1.70 (95% CI: 1.42 to 2.02, p < 0.001), sensitivity was 0.99 (95% CI: 0.93 to 1.00, p < 0.001), and specificity was 0.41 (95% CI: 0.31 to 0.52, p < 0.001). Stratifying by no CAD, nonobstructive CAD (worst stenosis <50%), or obstructive CAD, there were incrementally increasing adverse events.
Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.]]></description><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Clinical outcomes</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Coronary vessels</subject><subject>Drug therapy</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Myocardial Ischemia - mortality</subject><subject>Myocardial Revascularization</subject><subject>Prognosis</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90F9r2zAQAHBRNtY03RfYQxGM0r441cmSJfUthLYbdLT032s4S3LqYFuuZW_k289JMwZ72NMdx-_uuCPkC7AZMMgu1rM1WjvjbFeYMYADMgEpdZJKoz6QCVOpTIAZdUiOYlwzxjIN5hM55ABCZlpPSH7fhVUTYl9a-oLV4Gko6AI7V6Kli1C3Q-8dfQp1WHXYvm7ovFmV-_ySzunjJva-xm37g_9Z-l8UG0d_-B6TeYPVJpbxmHwssIr-8z5OyfP11dPiW3J7d_N9Mb9N2pRBn-QguPQSURjnhAavOFeKOee1Gm8oCsVzzqRxyAojM8xzYR0X3AluHTpIp-TsfW7bhbfBx35Zl9H6qsLGhyEutZScpTrTozz_rwQNYBgoJUf69R-6DkM3XjYqKYwxAmC7-mSvhrz2btl2ZY3dZvnnzyM43QOMFquiw8aW8a9LTbZb9xt0vIxk</recordid><startdate>20110308</startdate><enddate>20110308</enddate><creator>HULTEN, Edward A</creator><creator>CARBONARO, Salvatore</creator><creator>PETRILLO, Sara P</creator><creator>MITCHELL, Joshua D</creator><creator>VILLINES, Todd C</creator><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20110308</creationdate><title>Prognostic Value of Cardiac Computed Tomography Angiography: A Systematic Review and Meta-Analysis</title><author>HULTEN, Edward A ; CARBONARO, Salvatore ; PETRILLO, Sara P ; MITCHELL, Joshua D ; VILLINES, Todd C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p301t-b1425e5aa49dd481e722770dde87109ff72b2059da0f956abb4cd242d42cdad13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular system</topic><topic>Clinical outcomes</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Coronary vessels</topic><topic>Drug therapy</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Myocardial Ischemia - mortality</topic><topic>Myocardial Revascularization</topic><topic>Prognosis</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HULTEN, Edward A</creatorcontrib><creatorcontrib>CARBONARO, Salvatore</creatorcontrib><creatorcontrib>PETRILLO, Sara P</creatorcontrib><creatorcontrib>MITCHELL, Joshua D</creatorcontrib><creatorcontrib>VILLINES, Todd C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HULTEN, Edward A</au><au>CARBONARO, Salvatore</au><au>PETRILLO, Sara P</au><au>MITCHELL, Joshua D</au><au>VILLINES, Todd C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Value of Cardiac Computed Tomography Angiography: A Systematic Review and Meta-Analysis</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2011-03-08</date><risdate>2011</risdate><volume>57</volume><issue>10</issue><spage>1237</spage><epage>1247</epage><pages>1237-1247</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract><![CDATA[The purpose of this study was to systematically review and perform a meta-analysis of the ability of cardiac computed tomography angiography (CCTA) to predict future cardiovascular events and death.
The diagnostic accuracy of CCTA is well reported. The prognostic value of CCTA has been described in several studies, but many were underpowered. Pooling outcomes increases the power to predict rare events.
We searched multiple databases for longitudinal studies of CCTA with at least 3 months follow-up of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), consisting of death, myocardial infarction (MI), and revascularization. Annualized event rates were pooled using a bivariate mixed-effects binomial regression model to calculate summary likelihood ratios and receiver-operating characteristic curves.
Eighteen studies evaluated 9,592 patients with a median follow-up of 20 months. The pooled annualized event rate for obstructive (any vessel with >50% luminal stenosis) versus normal CCTA was 8.8% versus 0.17% per year for MACE (p < 0.05) and 3.2% versus 0.15% for death or MI (p < 0.05). The pooled negative likelihood ratio for MACE after normal CCTA findings was 0.008 (95% confidence interval [CI]: 0.0004 to 0.17, p < 0.001), the positive likelihood ratio was 1.70 (95% CI: 1.42 to 2.02, p < 0.001), sensitivity was 0.99 (95% CI: 0.93 to 1.00, p < 0.001), and specificity was 0.41 (95% CI: 0.31 to 0.52, p < 0.001). Stratifying by no CAD, nonobstructive CAD (worst stenosis <50%), or obstructive CAD, there were incrementally increasing adverse events.
Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.]]></abstract><cop>New York, NY</cop><pub>Elsevier</pub><pmid>21145688</pmid><doi>10.1016/j.jacc.2010.10.011</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular system Clinical outcomes Coronary Angiography - methods Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - mortality Coronary Stenosis - diagnostic imaging Coronary vessels Drug therapy Heart attacks Humans Investigative techniques, diagnostic techniques (general aspects) Medical sciences Mortality Myocardial Ischemia - mortality Myocardial Revascularization Prognosis Radiodiagnosis. Nmr imagery. Nmr spectrometry ROC Curve Sensitivity and Specificity Tomography, X-Ray Computed |
| title | Prognostic Value of Cardiac Computed Tomography Angiography: A Systematic Review and Meta-Analysis |
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