TY - JOUR
T1 - A computed tomography-based coronary lesion score to predict acute coronary syndrome among patients with acute chest pain and significant coronary stenosis on coronary computed tomographic angiogram
AU - Ferencik, Maros
AU - Schlett, Christopher L.
AU - Ghoshhajra, Brian B.
AU - Kriegel, Mathias F.
AU - Joshi, Subodh B.
AU - Maurovich-Horvat, Pal
AU - Rogers, Ian S.
AU - Banerji, Dahlia
AU - Bamberg, Fabian
AU - Truong, Quynh A.
AU - Brady, Thomas J.
AU - Nagurney, John T.
AU - Hoffmann, Udo
N1 - Funding Information:
This work was supported by Grant RO1 HL080053 from the National Institutes of Health , Bethesda, Maryland and supported in part by Siemens Medical Solutions, Forchheim, Germany and General Electric Healthcare, Princeton, New Jersey. Dr. Ferencik, Dr. Rogers, Dr. Truong, and Dr. Ghoshhajra were supported by Grant T32 HL076136 from the National Institutes of Health . Dr. Hoffmann has received research grants from Siemens Medical Solutions and General Electric Healthcare . Dr. Nagurney is funded by Biosite, San Diego, California for a biomarker research study.
PY - 2012/7/15
Y1 - 2012/7/15
N2 - We tested the hypothesis that morphologic lesion assessment helps detect acute coronary syndrome (ACS) during index hospitalization in patients with acute chest pain and significant stenosis on coronary computed tomographic angiogram (CTA). Patients who presented to an emergency department with chest pain but no objective signs of myocardial ischemia (nondiagnostic electrocardiogram and negative initial biomarkers) underwent CT angiography. CTA was analyzed for degree and length of stenosis, plaque area and volume, remodeling index, CT attenuation of plaque, and spotty calcium in all patients with significant stenosis (>50% in diameter) on CTA. ACS during index hospitalization was determined by a panel of 2 physicians blinded to results of CT angiography. For lesion characteristics associated with ACS, we determined cutpoints optimized for diagnostic accuracy and created lesion scores. For each score, we determined the odds ratio (OR) and discriminatory capacity for the prediction of ACS. Of the overall population of 368 patients, 34 had significant stenosis and 21 of those had ACS. Scores A (remodeling index plus spotty calcium: OR 3.5, 95% confidence interval [CI] 1.2 to 10.1, area under curve [AUC] 0.734), B (remodeling index plus spotty calcium plus stenosis length: OR 4.6, 95% CI 1.6 to 13.7, AUC 0.824), and C (remodeling index plus spotty calcium plus stenosis length plus plaque volume <90 HU: OR 3.4, 95% CI 1.5 to 7.9, AUC 0.833) were significantly associated with ACS. In conclusion, in patients presenting with acute chest pain and stenosis on coronary CTA, a CT-based score incorporating morphologic characteristics of coronary lesions had a good discriminatory value for detection of ACS during index hospitalization.
AB - We tested the hypothesis that morphologic lesion assessment helps detect acute coronary syndrome (ACS) during index hospitalization in patients with acute chest pain and significant stenosis on coronary computed tomographic angiogram (CTA). Patients who presented to an emergency department with chest pain but no objective signs of myocardial ischemia (nondiagnostic electrocardiogram and negative initial biomarkers) underwent CT angiography. CTA was analyzed for degree and length of stenosis, plaque area and volume, remodeling index, CT attenuation of plaque, and spotty calcium in all patients with significant stenosis (>50% in diameter) on CTA. ACS during index hospitalization was determined by a panel of 2 physicians blinded to results of CT angiography. For lesion characteristics associated with ACS, we determined cutpoints optimized for diagnostic accuracy and created lesion scores. For each score, we determined the odds ratio (OR) and discriminatory capacity for the prediction of ACS. Of the overall population of 368 patients, 34 had significant stenosis and 21 of those had ACS. Scores A (remodeling index plus spotty calcium: OR 3.5, 95% confidence interval [CI] 1.2 to 10.1, area under curve [AUC] 0.734), B (remodeling index plus spotty calcium plus stenosis length: OR 4.6, 95% CI 1.6 to 13.7, AUC 0.824), and C (remodeling index plus spotty calcium plus stenosis length plus plaque volume <90 HU: OR 3.4, 95% CI 1.5 to 7.9, AUC 0.833) were significantly associated with ACS. In conclusion, in patients presenting with acute chest pain and stenosis on coronary CTA, a CT-based score incorporating morphologic characteristics of coronary lesions had a good discriminatory value for detection of ACS during index hospitalization.
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U2 - 10.1016/j.amjcard.2012.02.066
DO - 10.1016/j.amjcard.2012.02.066
M3 - Article
C2 - 22481015
AN - SCOPUS:84862765282
SN - 0002-9149
VL - 110
SP - 183
EP - 189
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -