Abstract
Background Prior studies have shown a consistent relationship between coronary artery calcium (CAC) scores or the degree of coronary stenoses on coronary computed tomography angiography (CCTA) and all-cause mortality. Whether CCTA-targeted therapy, including intensive medical management, stress testing and/or invasive coronary angiography (ICA), can lead to a substantial reduction in adverse outcomes is not yet known. Methods We retrospectively analyzed 691 patients (55 ± 13 years, male = 63%) from a single medical practice who underwent a CAC scan and CCTA and were followed for a mean of 2.9 ± 1.0 years. Of these, 416 (60%) patients were asymptomatic. All changes in medications, coronary risk factors (including lipids profiles), downstream testing, revascularization procedures, and clinical events (myocardial infarction and death) were recorded. Results Among our patients cohort 279 (40%) had no coronary artery disease. The most severe stenosis was < 50% in 314 (46%) patients, 50-70% in 76 (11%) patients, and > 70% in 22 (3%) patients. A high frequency of medical therapy was employed for those patients with any degree of stenosis, while stress testing was primarily applied for patients with > 50% stenosis and ICA was primarily performed in those with > 70% stenosis. Only two non-cardiovascular deaths and no cardiovascular deaths occurred during the follow-up period. Conclusions Our findings support the hypotheses that among patients undergoing CCTA, comprehensive medical management, including targeted percutaneous coronary interventions and increasingly intensive medical therapy with progressively worse CCTA findings, can reduce event rates among patients with abnormal CCTA studies.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 468-473 |
| Number of pages | 6 |
| Journal | International Journal of Cardiology |
| Volume | 165 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jan 1 2013 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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Clinical outcomes following a strategy of optimized medical management and selective "downstream" procedures following coronary computed tomography angiography. / Uretsky, Seth; Rozanski, Alan; Supariwala, Azhar; Thotakura, Gargi; Kanneganti, Sirisha; Satyanarayana, Niriksha; Mantrala, Pranitha; Yeturi, Supraja Reddy; Peters, M. Robert; Fisher, Edward; Wolff, Steven D.
In: International Journal of Cardiology, Vol. 165, No. 3, 01.01.2013, p. 468-473.Research output: Contribution to journal › Article
TY - JOUR
T1 - Clinical outcomes following a strategy of optimized medical management and selective "downstream" procedures following coronary computed tomography angiography
AU - Uretsky, Seth
AU - Rozanski, Alan
AU - Supariwala, Azhar
AU - Thotakura, Gargi
AU - Kanneganti, Sirisha
AU - Satyanarayana, Niriksha
AU - Mantrala, Pranitha
AU - Yeturi, Supraja Reddy
AU - Peters, M. Robert
AU - Fisher, Edward
AU - Wolff, Steven D.
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Background Prior studies have shown a consistent relationship between coronary artery calcium (CAC) scores or the degree of coronary stenoses on coronary computed tomography angiography (CCTA) and all-cause mortality. Whether CCTA-targeted therapy, including intensive medical management, stress testing and/or invasive coronary angiography (ICA), can lead to a substantial reduction in adverse outcomes is not yet known. Methods We retrospectively analyzed 691 patients (55 ± 13 years, male = 63%) from a single medical practice who underwent a CAC scan and CCTA and were followed for a mean of 2.9 ± 1.0 years. Of these, 416 (60%) patients were asymptomatic. All changes in medications, coronary risk factors (including lipids profiles), downstream testing, revascularization procedures, and clinical events (myocardial infarction and death) were recorded. Results Among our patients cohort 279 (40%) had no coronary artery disease. The most severe stenosis was < 50% in 314 (46%) patients, 50-70% in 76 (11%) patients, and > 70% in 22 (3%) patients. A high frequency of medical therapy was employed for those patients with any degree of stenosis, while stress testing was primarily applied for patients with > 50% stenosis and ICA was primarily performed in those with > 70% stenosis. Only two non-cardiovascular deaths and no cardiovascular deaths occurred during the follow-up period. Conclusions Our findings support the hypotheses that among patients undergoing CCTA, comprehensive medical management, including targeted percutaneous coronary interventions and increasingly intensive medical therapy with progressively worse CCTA findings, can reduce event rates among patients with abnormal CCTA studies.
AB - Background Prior studies have shown a consistent relationship between coronary artery calcium (CAC) scores or the degree of coronary stenoses on coronary computed tomography angiography (CCTA) and all-cause mortality. Whether CCTA-targeted therapy, including intensive medical management, stress testing and/or invasive coronary angiography (ICA), can lead to a substantial reduction in adverse outcomes is not yet known. Methods We retrospectively analyzed 691 patients (55 ± 13 years, male = 63%) from a single medical practice who underwent a CAC scan and CCTA and were followed for a mean of 2.9 ± 1.0 years. Of these, 416 (60%) patients were asymptomatic. All changes in medications, coronary risk factors (including lipids profiles), downstream testing, revascularization procedures, and clinical events (myocardial infarction and death) were recorded. Results Among our patients cohort 279 (40%) had no coronary artery disease. The most severe stenosis was < 50% in 314 (46%) patients, 50-70% in 76 (11%) patients, and > 70% in 22 (3%) patients. A high frequency of medical therapy was employed for those patients with any degree of stenosis, while stress testing was primarily applied for patients with > 50% stenosis and ICA was primarily performed in those with > 70% stenosis. Only two non-cardiovascular deaths and no cardiovascular deaths occurred during the follow-up period. Conclusions Our findings support the hypotheses that among patients undergoing CCTA, comprehensive medical management, including targeted percutaneous coronary interventions and increasingly intensive medical therapy with progressively worse CCTA findings, can reduce event rates among patients with abnormal CCTA studies.
UR - http://www.scopus.com/inward/record.url?scp=84877086749&partnerID=8YFLogxK
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U2 - 10.1016/j.ijcard.2011.08.852
DO - 10.1016/j.ijcard.2011.08.852
M3 - Article
VL - 165
SP - 468
EP - 473
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 3
ER -