A combination of anatomical and functional evaluations improves the prediction of Cardiac event in patients with coronary artery bypass

Hideki Kawai, Masayoshi Sarai, Sadako Motoyama, Hajime Ito, Kayoko Takada, Hiroto Harigaya, Hiroshi Takahashi, Shuji Hashimoto, Yasushi Takagi, Motomi Ando, Hirofumi Anno, Junichi Ishii, Toyoaki Murohara, Yukio Ozaki

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG). Design: A retrospective, observational, single centre study. Setting and patients: 204 patients (84.3% men, mean age 68.7±7.6) undergoing CTA and MPI. Main outcome measures: CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of significant stenoses which were defined as the left main trunk ≥50% diameter stenosis, other native vessel stenosis ≥70% or graft stenosis ≥70%. Using a cut-off value with receiver-operating characteristics analysis, all patients were divided into four groups: group A (UCT=0, summed stress score (SSS)<4), group B (UCT≥1, SSS<4), group C (UCT=0 SSS≥4) and group D (UCT≥1, SSS≥4). Results: Cardiac events, as a composite end point including cardiac death, non-fatal myocardial infarction unstable angina requiring revascularisation and heartfailure hospitalisation, were observed in 27 patients fo a median follow-up of 27.5 months. The annual event rates were 1.1%, 2%, 5.7% and 12.9% of patients in groups A, B, C and D, respectively (log rank p value <0.0001). Adding UCT or SSS to a model with significant clinical factors including left ventricular ejection fraction, time since CABG and Euro SCORE II improved the prediction of events, while adding UCT and SSS to the model improved it greatly with increasing C-index, net reclassification improvement and integrated discrimination improvement. Conclusions: The combination of anatomical and functional evaluations non-invasively enhances the predictive accuracy of cardiac events in patients with CABG.

Original languageEnglish
Article number3
JournalBMJ Open
Volume3
Issue number11
DOIs
Publication statusPublished - 27-11-2013

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Coronary Artery Bypass
Pathologic Constriction
Myocardial Perfusion Imaging
Unstable Angina
Coronary Angiography
ROC Curve
Stroke Volume
Hospitalization
Myocardial Infarction
Outcome Assessment (Health Care)
Transplants
Computed Tomography Angiography

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kawai, Hideki ; Sarai, Masayoshi ; Motoyama, Sadako ; Ito, Hajime ; Takada, Kayoko ; Harigaya, Hiroto ; Takahashi, Hiroshi ; Hashimoto, Shuji ; Takagi, Yasushi ; Ando, Motomi ; Anno, Hirofumi ; Ishii, Junichi ; Murohara, Toyoaki ; Ozaki, Yukio. / A combination of anatomical and functional evaluations improves the prediction of Cardiac event in patients with coronary artery bypass. In: BMJ Open. 2013 ; Vol. 3, No. 11.
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title = "A combination of anatomical and functional evaluations improves the prediction of Cardiac event in patients with coronary artery bypass",
abstract = "Objective: To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG). Design: A retrospective, observational, single centre study. Setting and patients: 204 patients (84.3{\%} men, mean age 68.7±7.6) undergoing CTA and MPI. Main outcome measures: CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of significant stenoses which were defined as the left main trunk ≥50{\%} diameter stenosis, other native vessel stenosis ≥70{\%} or graft stenosis ≥70{\%}. Using a cut-off value with receiver-operating characteristics analysis, all patients were divided into four groups: group A (UCT=0, summed stress score (SSS)<4), group B (UCT≥1, SSS<4), group C (UCT=0 SSS≥4) and group D (UCT≥1, SSS≥4). Results: Cardiac events, as a composite end point including cardiac death, non-fatal myocardial infarction unstable angina requiring revascularisation and heartfailure hospitalisation, were observed in 27 patients fo a median follow-up of 27.5 months. The annual event rates were 1.1{\%}, 2{\%}, 5.7{\%} and 12.9{\%} of patients in groups A, B, C and D, respectively (log rank p value <0.0001). Adding UCT or SSS to a model with significant clinical factors including left ventricular ejection fraction, time since CABG and Euro SCORE II improved the prediction of events, while adding UCT and SSS to the model improved it greatly with increasing C-index, net reclassification improvement and integrated discrimination improvement. Conclusions: The combination of anatomical and functional evaluations non-invasively enhances the predictive accuracy of cardiac events in patients with CABG.",
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A combination of anatomical and functional evaluations improves the prediction of Cardiac event in patients with coronary artery bypass. / Kawai, Hideki; Sarai, Masayoshi; Motoyama, Sadako; Ito, Hajime; Takada, Kayoko; Harigaya, Hiroto; Takahashi, Hiroshi; Hashimoto, Shuji; Takagi, Yasushi; Ando, Motomi; Anno, Hirofumi; Ishii, Junichi; Murohara, Toyoaki; Ozaki, Yukio.

In: BMJ Open, Vol. 3, No. 11, 3, 27.11.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A combination of anatomical and functional evaluations improves the prediction of Cardiac event in patients with coronary artery bypass

AU - Kawai, Hideki

AU - Sarai, Masayoshi

AU - Motoyama, Sadako

AU - Ito, Hajime

AU - Takada, Kayoko

AU - Harigaya, Hiroto

AU - Takahashi, Hiroshi

AU - Hashimoto, Shuji

AU - Takagi, Yasushi

AU - Ando, Motomi

AU - Anno, Hirofumi

AU - Ishii, Junichi

AU - Murohara, Toyoaki

AU - Ozaki, Yukio

PY - 2013/11/27

Y1 - 2013/11/27

N2 - Objective: To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG). Design: A retrospective, observational, single centre study. Setting and patients: 204 patients (84.3% men, mean age 68.7±7.6) undergoing CTA and MPI. Main outcome measures: CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of significant stenoses which were defined as the left main trunk ≥50% diameter stenosis, other native vessel stenosis ≥70% or graft stenosis ≥70%. Using a cut-off value with receiver-operating characteristics analysis, all patients were divided into four groups: group A (UCT=0, summed stress score (SSS)<4), group B (UCT≥1, SSS<4), group C (UCT=0 SSS≥4) and group D (UCT≥1, SSS≥4). Results: Cardiac events, as a composite end point including cardiac death, non-fatal myocardial infarction unstable angina requiring revascularisation and heartfailure hospitalisation, were observed in 27 patients fo a median follow-up of 27.5 months. The annual event rates were 1.1%, 2%, 5.7% and 12.9% of patients in groups A, B, C and D, respectively (log rank p value <0.0001). Adding UCT or SSS to a model with significant clinical factors including left ventricular ejection fraction, time since CABG and Euro SCORE II improved the prediction of events, while adding UCT and SSS to the model improved it greatly with increasing C-index, net reclassification improvement and integrated discrimination improvement. Conclusions: The combination of anatomical and functional evaluations non-invasively enhances the predictive accuracy of cardiac events in patients with CABG.

AB - Objective: To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG). Design: A retrospective, observational, single centre study. Setting and patients: 204 patients (84.3% men, mean age 68.7±7.6) undergoing CTA and MPI. Main outcome measures: CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of significant stenoses which were defined as the left main trunk ≥50% diameter stenosis, other native vessel stenosis ≥70% or graft stenosis ≥70%. Using a cut-off value with receiver-operating characteristics analysis, all patients were divided into four groups: group A (UCT=0, summed stress score (SSS)<4), group B (UCT≥1, SSS<4), group C (UCT=0 SSS≥4) and group D (UCT≥1, SSS≥4). Results: Cardiac events, as a composite end point including cardiac death, non-fatal myocardial infarction unstable angina requiring revascularisation and heartfailure hospitalisation, were observed in 27 patients fo a median follow-up of 27.5 months. The annual event rates were 1.1%, 2%, 5.7% and 12.9% of patients in groups A, B, C and D, respectively (log rank p value <0.0001). Adding UCT or SSS to a model with significant clinical factors including left ventricular ejection fraction, time since CABG and Euro SCORE II improved the prediction of events, while adding UCT and SSS to the model improved it greatly with increasing C-index, net reclassification improvement and integrated discrimination improvement. Conclusions: The combination of anatomical and functional evaluations non-invasively enhances the predictive accuracy of cardiac events in patients with CABG.

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