title: Incremental prognostic value of computed tomography in stroke: rationale and design of the IMPACTS study.
abstract: This study was designed to determine the prognostic value of coronary computed tomography angiography (CCTA) in ischemic stroke patients and to identify any incremental risk stratification benefits of CCTA findings compared with coronary artery calcium scoring (CACS) and traditional Framingham risk scores (FRS) in ischemic stroke patients without chest pain. IMPACTS is a prospective, multicenter, observational cohort study in which at least seven centers in Korea will participate. All participants will be enrolled in this study after providing informed consent. Nine hundred total ischemic stroke patients without chest pain will be enrolled and will undergo CACS and CCTA. All participants will be followed-up for a minimum of 24 months to determine the endpoints. The primary endpoint will be occurrence of major adverse cardiovascular events (MACEs), defined as all-cause mortality, cardiovascular death, myocardial infarction, or cardiovascular events requiring hospitalization and revascularization either by percutaneous coronary intervention or by coronary artery bypass graft after 90 days of index testing during the follow-up period. Patient enrollment should be completed within 2.5 years. We plan to analyze and identify the CCTA predictors of MACEs. In addition, we will compare several models used to assess independent relationships between the variables and MACEs using a shared frailty model and therefore determine the incremental prognostic value of CCTA findings compared with either the CACS or FRS. The results of IMPACTS will provide valuable information for risk stratification with CCTA in ischemic stroke patients without chest pain.
authors.affiliation: Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine Research Institute, Busan, Republic of Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. khuhz@yuhs.ac.
authors.forename: Jin
authors.initials: J
authors.lastname: Hur
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Chun
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Joon-Won
authors.initials: JW
authors.lastname: Kang
authors.affiliation: Department of Radiology, Research Institute of Clinical Medicine, Institute of Cardiovascular Research, Chonbuk National University Hospital and Medical School, Jeonju, Republic of Korea.
authors.forename: Gong Yong
authors.initials: GY
authors.lastname: Jin
authors.affiliation: Department of Radiology, Research Institute of Clinical Medicine, Institute of Cardiovascular Research, Chonbuk National University Hospital and Medical School, Jeonju, Republic of Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hwan Seok
authors.initials: HS
authors.lastname: Yong
authors.affiliation: Department of Radiology, Dong-A University College of Medicine, Busan, Republic of Korea.
authors.forename: Eun-Ju
authors.initials: EJ
authors.lastname: Kang
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei Biomedical Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyunghwa
authors.initials: K
authors.lastname: Han
authors.affiliation: Department of Business Administration, College of Business and Economics, Chung-Ang University, Seoul, Republic of Korea.
authors.forename: Hoon-Suk
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
mesh_terms: D002985:Clinical Protocols; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003661:Decision Support Techniques; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D056910:Republic of Korea; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D013997:Time Factors; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy
keywords: Coronary artery disease (CAD); Coronary computed tomography angiography (CCTA); Major adverse cardiac events (MACE); Prognosis; Stroke