Predictive Value of Cardiac Computed Tomography and the Impact of Renal Function on All Cause Mortality (from Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes) - 15/05/13

Doi : 10.1016/j.amjcard.2013.02.004

Girish Dwivedi, PhD ^a, Myra Cocker, PhD ^a, Yeung Yam, BSc ^a, Stephan Achenbach, MD ^b, Mouaz Al-Mallah, MD, MSc ^c, Daniel S. Berman, MD ^d, Matthew J. Budoff, MD ^e, Filippo Cademartiri, MD, PhD ^f,^g, Tracy Q. Callister, MD ^h, Hyuk-Jae Chang, MD, PhD ⁱ, Victor Cheng, MD ^j, Kavitha M. Chinnaiyan, MD ^k, Augustin Delago, MD ^l, Allison M. Dunning, MSc ^m, Martin Hadamitzky, MD ^p, Jörg Hausleiter, MD ^p, Philipp A. Kaufmann, MD ^q, Troy M. LaBounty, MD ^d, Fay Lin, MD ^n,^o, Erica Maffei, MD ^f,^g, Gilbert L. Raff, MD ^k, Leslee J. Shaw, PhD ^r, Todd C. Villines, MD ^s, James K. Min, MD ^d, Benjamin J.W. Chow, MD ^a,^⁎
CONFIRM Investigators
^a Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
^b Department of Medicine, University of Erlangen, Erlangen, Germany
^c Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Michigan
^d Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California
^e Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California
^f Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy
^g Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
^h Tennessee Heart and Vascular Institute, Hendersonville, Tennessee
ⁱ Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea
^j Department of Cardiovascular CT, Oklahoma Heart Institute, Tulsa, Oklahoma
^k William Beaumont Hospital, Royal Oaks, Michigan
^l Capitol Cardiology Associates, Albany, New York
^m Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, New York
ⁿ Department of Medicine, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, New York
^o Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, New York
^p Division of Cardiology, Deutsches Herzzentrum München, Munich, Germany
^q Cardiac Imaging, University Hospital, Zurich, Switzerland
^r Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
^s Department of Medicine, Walter Reed Medical Center, Washington, District of Columbia

Corresponding author: Tel: 613-761-4044; fax: 613-761-4929.

Abstract

Patients with chronic kidney disease have a worse cardiovascular prognosis than those without. The aim of this study was to determine the incremental prognostic value of coronary computed tomographic angiography in predicting mortality across the entire spectrum of renal function in patients with known or suspected coronary artery disease (CAD). A large international multicenter registry was queried, and patients with left ventricular ejection fraction (LVEF) and creatinine data were screened. National Cholesterol Education Program Adult Treatment Panel III risk was calculated. Coronary computed tomographic angiographic results were evaluated for CAD severity (normal, nonobstructive, or obstructive) and an LVEF <50%. Patients were followed for the end point of all-cause mortality. Among 5,655 patients meeting the study criteria, follow-up was available for 5,572 (98.9%; median follow-up duration 18.6 months). All-cause mortality (66 deaths) significantly increased with every 10-unit decrease in renal function (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.07 to 1.41). All-cause mortality occurred in 0.33% of patients without coronary atherosclerosis, 1.82% of patients with nonobstructive CAD, and 2.43% of patients with obstructive CAD. Multivariate Cox proportional-hazards models revealed that impaired renal function (HR 2.29, 95% CI 1.65 to 3.18), CAD severity (HR 1.81, 95% CI 1.31 to 2.51), and an abnormal LVEF (HR 4.16, 95% CI 2.45 to 7.08) were independent predictors of all-cause mortality. In conclusion, coronary computed tomographic angiographic measures of CAD severity and the LVEF provide effective risk stratification across a wide spectrum of renal function. Furthermore, renal dysfunction, CAD severity, and the LVEF have additive value for predicting all-cause death in patients with suspected obstructive CAD.

Le texte complet de cet article est disponible en PDF.

Plan

Methods

Results

Discussion

Dr. Dwivedi is supported by the Dowager Countess Eleanor Peel Trust (Peel and Rothwell Jackson Postgraduate Travelling Fellowship), London, United Kingdom; the Whit & Heather Tucker Endowed Research Fellowship in Cardiology, Ottawa, Ontario, Canada; and the Banting Postdoctoral Fellowship, Ottawa, Ontario, Canada. Dr. Kaufman is supported by the Swiss National Science Foundation, Bern, Switzerland. Dr. Chow is supported by New Investigator Award MSH-83718 from the Canadian Institutes of Health Research, Ottawa, Ontario, Canada.

See page 1568 for disclosure information.

Export

Vol 111 - N° 11

P. 1563-1569 - juin 2013 Retour au numéro

Article précédent

Impact of Adding Ezetimibe to Statin to Achieve Low-Density Lipoprotein Cholesterol Goal (from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE] Trial)
David J. Maron, Pamela M. Hartigan, David R. Neff, William S. Weintraub, William E. Boden, COURAGE Trial Investigators

| Article suivant

Comparison of Effects of Serum n-3 to n-6 Polyunsaturated Fatty Acid Ratios on Coronary Atherosclerosis in Patients Treated With Pitavastatin or Pravastatin Undergoing Percutaneous Coronary Intervention
Tsuyoshi Nozue, Shingo Yamamoto, Shinichi Tohyama, Kazuki Fukui, Shigeo Umezawa, Yuko Onishi, Tomoyuki Kunishima, Akira Sato, Toshihiro Nozato, Shogo Miyake, Youichi Takeyama, Yoshihiro Morino, Takao Yamauchi, Toshiya Muramatsu, Kiyoshi Hibi, Mitsuyasu Terashima, Ichiro Michishita

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Predictive Value of Cardiac Computed Tomography and the Impact of Renal Function on All Cause Mortality (from Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes) - 15/05/13

Abstract

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL