title: Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center.
abstract: BACKGROUND
  Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center.
  
  
  METHODS
  We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis), non-obstructive (<50% stenosis), and no coronary artery disease (no angiographic disease). Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization) were obtained.
  
  
  RESULTS
  Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13-34 months), the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001). The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001).
  
  
  CONCLUSIONS
  Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was associated with a significantly increased incidence of ischemic stroke. There was also a direct correlation between the severity of coronary artery disease on CCTA and cardiovascular prognosis over the follow-up period of 24 months.
authors.affiliation: Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Charles K
authors.initials: CK
authors.lastname: Lin
authors.affiliation: Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: McDonough
authors.affiliation: Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Prentice
authors.affiliation: Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Thomas
authors.affiliation: Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Steel
authors.affiliation: Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Rubal
authors.affiliation: Cardiology Service, Madigan Army Medical Center, Tacoma, WA, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Shry
authors.affiliation: Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.affiliation: Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Hulten
authors.affiliation: Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Slim
keywords: Coronary computed tomography angiography; computed tomography; coronary artery disease; ischemic stroke; prognosis