Clinical outcomes following a strategy of optimized medical management and selective "downstream" procedures following coronary computed tomography angiography

Seth Uretsky, Alan Rozanski, Azhar Supariwala, Gargi Thotakura, Sirisha Kanneganti, Niriksha Satyanarayana, Pranitha Mantrala, Supraja Reddy Yeturi, M. Robert Peters, Edward Fisher, Steven D. Wolff

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)468-473
Number of pages6
JournalInternational Journal of Cardiology
Volume165
Issue number3
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Fingerprint

Pathologic Constriction
Coronary Angiography
Coronary Vessels
Calcium
Computed Tomography Angiography
Coronary Stenosis
Percutaneous Coronary Intervention
Coronary Artery Disease
Therapeutics
Myocardial Infarction
Lipids
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Clinical outcomes following a strategy of optimized medical management and selective "downstream" procedures following coronary computed tomography angiography. In: International Journal of Cardiology. 2013 ; Vol. 165, No. 3. pp. 468-473.
@article{5119e1dd020546aeadbc7e0e4f2ee13e,
title = "Clinical outcomes following a strategy of optimized medical management and selective {"}downstream{"} procedures following coronary computed tomography angiography",
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.",
author = "Seth Uretsky and Alan Rozanski and Azhar Supariwala and Gargi Thotakura and Sirisha Kanneganti and Niriksha Satyanarayana and Pranitha Mantrala and Yeturi, {Supraja Reddy} and Peters, {M. Robert} and Edward Fisher and Wolff, {Steven D.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.ijcard.2011.08.852",
language = "English (US)",
volume = "165",
pages = "468--473",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

Uretsky, S, Rozanski, A, Supariwala, A, Thotakura, G, Kanneganti, S, Satyanarayana, N, Mantrala, P, Yeturi, SR, Peters, MR, Fisher, E & Wolff, SD 2013, 'Clinical outcomes following a strategy of optimized medical management and selective "downstream" procedures following coronary computed tomography angiography', International Journal of Cardiology, vol. 165, no. 3, pp. 468-473. https://doi.org/10.1016/j.ijcard.2011.08.852

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 journalArticle

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

UR - http://www.scopus.com/inward/citedby.url?scp=84877086749&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2011.08.852

DO - 10.1016/j.ijcard.2011.08.852

M3 - Article

C2 - 21968073

AN - SCOPUS:84877086749

VL - 165

SP - 468

EP - 473

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 3

ER -