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.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Girish
authors.initials: G
authors.lastname: Dwivedi
authors.forename: Myra
authors.initials: M
authors.lastname: Cocker
authors.forename: Yeung
authors.initials: Y
authors.lastname: Yam
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Victor
authors.initials: V
authors.lastname: Cheng
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
authors.forename: Augustin
authors.initials: A
authors.lastname: Delago
authors.forename: Allison M
authors.initials: AM
authors.lastname: Dunning
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.forename: Troy M
authors.initials: TM
authors.lastname: LaBounty
authors.forename: Fay
authors.initials: F
authors.lastname: Lin
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.forename: Gilbert L
authors.initials: GL
authors.lastname: Raff
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
mesh_terms: D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D005500:Follow-Up Studies; D014943:Global Health; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*