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)

Girish Dwivedi; Myra Cocker; Yeung Yam; Stephan Achenbach; Mouaz Al-Mallah; Daniel S. Berman; Matthew J. Budoff; Filippo Cademartiri; Tracy Q. Callister; Hyuk Jae Chang; Victor Cheng; Kavitha M. Chinnaiyan; Augustin Delago; Allison M. Dunning; Martin Hadamitzky; Jörg Hausleiter; Philipp A. Kaufmann; Troy M. Labounty; Fay Lin; Erica Maffei; Gilbert L. Raff; Leslee J. Shaw; Todd C. Villines; James K. Min; Benjamin J.W. Chow

doi:10.1016/j.amjcard.2013.02.004

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)

Girish Dwivedi, Myra Cocker, Yeung Yam, Stephan Achenbach, Mouaz Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Victor Cheng, Kavitha M. Chinnaiyan, Augustin Delago, Allison M. Dunning, Martin Hadamitzky, Jörg Hausleiter, Philipp A. Kaufmann, Troy M. Labounty, Fay Lin, Erica MaffeiGilbert L. Raff, Leslee J. Shaw, Todd C. Villines, James K. Min, Benjamin J.W. Chow

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1563-1569
Number of pages	7
Journal	American Journal of Cardiology
Volume	111
Issue number	11
DOIs	https://doi.org/10.1016/j.amjcard.2013.02.004
Publication status	Published - 2013 Jun 1

Bibliographical note

Funding Information:
Dr. Achenbach receives grant support from Siemens Healthcare , Erlangen, Germany, and Bayer Schering Pharma AG , Berlin, Germany, and is a consultant for Servier, Neuilly-sur-Seine, France. Dr. Budoff is on the speaker's bureau of GE Healthcare. Dr. Cademartiri receives grant support from GE Healthcare , is a consultant for Servier, and is on the speaker's bureau of Bracco, Milan, Italy. Dr. Chinnaiyan receives grant support from Bayer Pharma AG and Blue Cross Blue Shield Blue Care Network of Michigan , Grand Rapids, Michigan. Dr. Kaufmann receives grant support from the Swiss National Science Foundation , Bern, Switzerland, and GE Healthcare. Dr. Maffei receives grant support from GE Healthcare . Dr. Raff receives grant support from Siemens Healthcare , Blue Cross Blue Shield Blue Care Network of Michigan , and Bayer Pharma AG . Dr. Min receives research support from and is on the speaker's bureau of GE Healthcare . Dr. Chow receives research support from GE Healthcare , Milwaukee, Wisconsin; Pfizer, Inc. , New York, New York; and AstraZeneca , Wilmington, Delaware. Dr. Chow receives fellowship support from GE Healthcare and educational support from TeraRecon Inc , Foster City, California.

Funding Information:
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.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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Dwivedi, G., Cocker, M., Yam, Y., Achenbach, S., Al-Mallah, M., Berman, D. S., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Cheng, V., Chinnaiyan, K. M., Delago, A., Dunning, A. M., Hadamitzky, M., Hausleiter, J., Kaufmann, P. A., Labounty, T. M., Lin, F., ... Chow, B. J. W. (2013). 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). American Journal of Cardiology, 111(11), 1563-1569. https://doi.org/10.1016/j.amjcard.2013.02.004

Dwivedi, Girish ; Cocker, Myra ; Yam, Yeung ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Berman, Daniel S. ; Budoff, Matthew J. ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Cheng, Victor ; Chinnaiyan, Kavitha M. ; Delago, Augustin ; Dunning, Allison M. ; Hadamitzky, Martin ; Hausleiter, Jörg ; Kaufmann, Philipp A. ; Labounty, Troy M. ; Lin, Fay ; Maffei, Erica ; Raff, Gilbert L. ; Shaw, Leslee J. ; Villines, Todd C. ; Min, James K. ; Chow, Benjamin J.W. / 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). In: American Journal of Cardiology. 2013 ; Vol. 111, No. 11. pp. 1563-1569.

@article{c28210e409c14c59afcd7fd34a746ec5,

title = "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)",

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.",

author = "Girish Dwivedi and Myra Cocker and Yeung Yam and Stephan Achenbach and Mouaz Al-Mallah and Berman, {Daniel S.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Victor Cheng and Chinnaiyan, {Kavitha M.} and Augustin Delago and Dunning, {Allison M.} and Martin Hadamitzky and J{\"o}rg Hausleiter and Kaufmann, {Philipp A.} and Labounty, {Troy M.} and Fay Lin and Erica Maffei and Raff, {Gilbert L.} and Shaw, {Leslee J.} and Villines, {Todd C.} and Min, {James K.} and Chow, {Benjamin J.W.}",

note = "Funding Information: Dr. Achenbach receives grant support from Siemens Healthcare , Erlangen, Germany, and Bayer Schering Pharma AG , Berlin, Germany, and is a consultant for Servier, Neuilly-sur-Seine, France. Dr. Budoff is on the speaker's bureau of GE Healthcare. Dr. Cademartiri receives grant support from GE Healthcare , is a consultant for Servier, and is on the speaker's bureau of Bracco, Milan, Italy. Dr. Chinnaiyan receives grant support from Bayer Pharma AG and Blue Cross Blue Shield Blue Care Network of Michigan , Grand Rapids, Michigan. Dr. Kaufmann receives grant support from the Swiss National Science Foundation , Bern, Switzerland, and GE Healthcare. Dr. Maffei receives grant support from GE Healthcare . Dr. Raff receives grant support from Siemens Healthcare , Blue Cross Blue Shield Blue Care Network of Michigan , and Bayer Pharma AG . Dr. Min receives research support from and is on the speaker's bureau of GE Healthcare . Dr. Chow receives research support from GE Healthcare , Milwaukee, Wisconsin; Pfizer, Inc. , New York, New York; and AstraZeneca , Wilmington, Delaware. Dr. Chow receives fellowship support from GE Healthcare and educational support from TeraRecon Inc , Foster City, California. Funding Information: 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. ",

year = "2013",

month = jun,

day = "1",

doi = "10.1016/j.amjcard.2013.02.004",

language = "English",

volume = "111",

pages = "1563--1569",

journal = "American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier Inc.",

number = "11",

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Dwivedi, G, Cocker, M, Yam, Y, Achenbach, S, Al-Mallah, M, Berman, DS, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Cheng, V, Chinnaiyan, KM, Delago, A, Dunning, AM, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Labounty, TM, Lin, F, Maffei, E, Raff, GL, Shaw, LJ, Villines, TC, Min, JK & Chow, BJW 2013, '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)', American Journal of Cardiology, vol. 111, no. 11, pp. 1563-1569. https://doi.org/10.1016/j.amjcard.2013.02.004

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). / Dwivedi, Girish; Cocker, Myra; Yam, Yeung; Achenbach, Stephan; Al-Mallah, Mouaz; Berman, Daniel S.; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Cheng, Victor; Chinnaiyan, Kavitha M.; Delago, Augustin; Dunning, Allison M.; Hadamitzky, Martin; Hausleiter, Jörg; Kaufmann, Philipp A.; Labounty, Troy M.; Lin, Fay; Maffei, Erica; Raff, Gilbert L.; Shaw, Leslee J.; Villines, Todd C.; Min, James K.; Chow, Benjamin J.W.

In: American Journal of Cardiology, Vol. 111, No. 11, 01.06.2013, p. 1563-1569.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - 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)

AU - Dwivedi, Girish

AU - Cocker, Myra

AU - Yam, Yeung

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Cheng, Victor

AU - Chinnaiyan, Kavitha M.

AU - Delago, Augustin

AU - Dunning, Allison M.

AU - Hadamitzky, Martin

AU - Hausleiter, Jörg

AU - Kaufmann, Philipp A.

AU - Labounty, Troy M.

AU - Lin, Fay

AU - Maffei, Erica

AU - Raff, Gilbert L.

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Min, James K.

AU - Chow, Benjamin J.W.

N1 - Funding Information: Dr. Achenbach receives grant support from Siemens Healthcare , Erlangen, Germany, and Bayer Schering Pharma AG , Berlin, Germany, and is a consultant for Servier, Neuilly-sur-Seine, France. Dr. Budoff is on the speaker's bureau of GE Healthcare. Dr. Cademartiri receives grant support from GE Healthcare , is a consultant for Servier, and is on the speaker's bureau of Bracco, Milan, Italy. Dr. Chinnaiyan receives grant support from Bayer Pharma AG and Blue Cross Blue Shield Blue Care Network of Michigan , Grand Rapids, Michigan. Dr. Kaufmann receives grant support from the Swiss National Science Foundation , Bern, Switzerland, and GE Healthcare. Dr. Maffei receives grant support from GE Healthcare . Dr. Raff receives grant support from Siemens Healthcare , Blue Cross Blue Shield Blue Care Network of Michigan , and Bayer Pharma AG . Dr. Min receives research support from and is on the speaker's bureau of GE Healthcare . Dr. Chow receives research support from GE Healthcare , Milwaukee, Wisconsin; Pfizer, Inc. , New York, New York; and AstraZeneca , Wilmington, Delaware. Dr. Chow receives fellowship support from GE Healthcare and educational support from TeraRecon Inc , Foster City, California. Funding Information: 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.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - 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.

AB - 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.

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