Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography

A systematic review and meta-analysis

Chadi Ayoub, Fernanda Erthal, Mahmoud A. Abdelsalam, Mohammad H Murad, Zhen Wang, Patricia J. Erwin, Graham S. Hillis, Leonard Kritharides, Benjamin J.W. Chow

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background The segment involvement score (SIS) is a semiquantitative measure of the extent of atherosclerosis burden by coronary computed tomography angiography (CTA). We sought to evaluate by meta-analysis the prognostic value of SIS, and to compare it with other CTA measures of coronary artery disease (CAD). Methods Electronic databases from 1946 to January 2016 were searched. Studies reporting SIS, or an equivalent measure by coronary CTA, and clinical outcomes were included. Maximally adjusted hazard ratios (HR), predominantly for clinical variables, were extracted for SIS, obstructive CAD, Agatston coronary artery calcium score, and plaque composition. These were pooled using DerSimonian-Laird random effects models. Results Eleven nonrandomized studies with good methodological quality enrolling 9777 subjects (mean age 61 ± 11 years, 57% male, mean follow up 3.3 years) who had 472 (4.8%) MACE (cardiac or all cause death, non-fatal myocardial infarction or late revascularization), were included. SIS (per segment increase) had pooled HR of 1.25 (95% CI: 1.16,1.35; I2 = 71.4%, p < 0.001) for MACE. HR for MACE was 1.37 (95% CI: 1.32,1.42; I2 = 95.6%, p < 0.001) for number of segments with stenosis (per segment increase), 3.39 (95% CI: 1.65,6.99; I2 = 87.8%, p = 0.001) for obstructive CAD (binary variable) and 1.00 (95% CI: 1.00,1.01; I2 = 75.0%, p = 0.490) for Agatston score (per unit increase). HRs by plaque composition (calcified, non-calcified and mixed; per segment change) were 1.24 (95% CI: 1.10,1.39; I2 = 81.6%, p = 0.001), 1.20 (95% CI: 0.97,1.48; I2 = 92.9%, p = 0.093) and 1.27 (95% CI: 1.03,1.58; I2 = 89.8%, p = 0.029), respectively. Conclusion Despite heterogeneity in endpoints, extent of CAD as quantified by SIS on coronary CTA is a strong, independent predictor of cardiovascular events.

Original languageEnglish (US)
Pages (from-to)258-267
Number of pages10
JournalJournal of Cardiovascular Computed Tomography
Volume11
Issue number4
DOIs
StatePublished - Jul 1 2017

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Meta-Analysis
Coronary Artery Disease
Tomography
Cause of Death
Coronary Vessels
Pathologic Constriction
Myocardial Infarction
Databases
Calcium
Computed Tomography Angiography

Keywords

  • Atherosclerosis
  • Coronary
  • Coronary computed tomography
  • Prognosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography : A systematic review and meta-analysis. / Ayoub, Chadi; Erthal, Fernanda; Abdelsalam, Mahmoud A.; Murad, Mohammad H; Wang, Zhen; Erwin, Patricia J.; Hillis, Graham S.; Kritharides, Leonard; Chow, Benjamin J.W.

In: Journal of Cardiovascular Computed Tomography, Vol. 11, No. 4, 01.07.2017, p. 258-267.

Research output: Contribution to journalArticle

Ayoub, Chadi ; Erthal, Fernanda ; Abdelsalam, Mahmoud A. ; Murad, Mohammad H ; Wang, Zhen ; Erwin, Patricia J. ; Hillis, Graham S. ; Kritharides, Leonard ; Chow, Benjamin J.W. / Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography : A systematic review and meta-analysis. In: Journal of Cardiovascular Computed Tomography. 2017 ; Vol. 11, No. 4. pp. 258-267.
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title = "Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography: A systematic review and meta-analysis",
abstract = "Background The segment involvement score (SIS) is a semiquantitative measure of the extent of atherosclerosis burden by coronary computed tomography angiography (CTA). We sought to evaluate by meta-analysis the prognostic value of SIS, and to compare it with other CTA measures of coronary artery disease (CAD). Methods Electronic databases from 1946 to January 2016 were searched. Studies reporting SIS, or an equivalent measure by coronary CTA, and clinical outcomes were included. Maximally adjusted hazard ratios (HR), predominantly for clinical variables, were extracted for SIS, obstructive CAD, Agatston coronary artery calcium score, and plaque composition. These were pooled using DerSimonian-Laird random effects models. Results Eleven nonrandomized studies with good methodological quality enrolling 9777 subjects (mean age 61 ± 11 years, 57{\%} male, mean follow up 3.3 years) who had 472 (4.8{\%}) MACE (cardiac or all cause death, non-fatal myocardial infarction or late revascularization), were included. SIS (per segment increase) had pooled HR of 1.25 (95{\%} CI: 1.16,1.35; I2 = 71.4{\%}, p < 0.001) for MACE. HR for MACE was 1.37 (95{\%} CI: 1.32,1.42; I2 = 95.6{\%}, p < 0.001) for number of segments with stenosis (per segment increase), 3.39 (95{\%} CI: 1.65,6.99; I2 = 87.8{\%}, p = 0.001) for obstructive CAD (binary variable) and 1.00 (95{\%} CI: 1.00,1.01; I2 = 75.0{\%}, p = 0.490) for Agatston score (per unit increase). HRs by plaque composition (calcified, non-calcified and mixed; per segment change) were 1.24 (95{\%} CI: 1.10,1.39; I2 = 81.6{\%}, p = 0.001), 1.20 (95{\%} CI: 0.97,1.48; I2 = 92.9{\%}, p = 0.093) and 1.27 (95{\%} CI: 1.03,1.58; I2 = 89.8{\%}, p = 0.029), respectively. Conclusion Despite heterogeneity in endpoints, extent of CAD as quantified by SIS on coronary CTA is a strong, independent predictor of cardiovascular events.",
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T1 - Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography

T2 - A systematic review and meta-analysis

AU - Ayoub, Chadi

AU - Erthal, Fernanda

AU - Abdelsalam, Mahmoud A.

AU - Murad, Mohammad H

AU - Wang, Zhen

AU - Erwin, Patricia J.

AU - Hillis, Graham S.

AU - Kritharides, Leonard

AU - Chow, Benjamin J.W.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background The segment involvement score (SIS) is a semiquantitative measure of the extent of atherosclerosis burden by coronary computed tomography angiography (CTA). We sought to evaluate by meta-analysis the prognostic value of SIS, and to compare it with other CTA measures of coronary artery disease (CAD). Methods Electronic databases from 1946 to January 2016 were searched. Studies reporting SIS, or an equivalent measure by coronary CTA, and clinical outcomes were included. Maximally adjusted hazard ratios (HR), predominantly for clinical variables, were extracted for SIS, obstructive CAD, Agatston coronary artery calcium score, and plaque composition. These were pooled using DerSimonian-Laird random effects models. Results Eleven nonrandomized studies with good methodological quality enrolling 9777 subjects (mean age 61 ± 11 years, 57% male, mean follow up 3.3 years) who had 472 (4.8%) MACE (cardiac or all cause death, non-fatal myocardial infarction or late revascularization), were included. SIS (per segment increase) had pooled HR of 1.25 (95% CI: 1.16,1.35; I2 = 71.4%, p < 0.001) for MACE. HR for MACE was 1.37 (95% CI: 1.32,1.42; I2 = 95.6%, p < 0.001) for number of segments with stenosis (per segment increase), 3.39 (95% CI: 1.65,6.99; I2 = 87.8%, p = 0.001) for obstructive CAD (binary variable) and 1.00 (95% CI: 1.00,1.01; I2 = 75.0%, p = 0.490) for Agatston score (per unit increase). HRs by plaque composition (calcified, non-calcified and mixed; per segment change) were 1.24 (95% CI: 1.10,1.39; I2 = 81.6%, p = 0.001), 1.20 (95% CI: 0.97,1.48; I2 = 92.9%, p = 0.093) and 1.27 (95% CI: 1.03,1.58; I2 = 89.8%, p = 0.029), respectively. Conclusion Despite heterogeneity in endpoints, extent of CAD as quantified by SIS on coronary CTA is a strong, independent predictor of cardiovascular events.

AB - Background The segment involvement score (SIS) is a semiquantitative measure of the extent of atherosclerosis burden by coronary computed tomography angiography (CTA). We sought to evaluate by meta-analysis the prognostic value of SIS, and to compare it with other CTA measures of coronary artery disease (CAD). Methods Electronic databases from 1946 to January 2016 were searched. Studies reporting SIS, or an equivalent measure by coronary CTA, and clinical outcomes were included. Maximally adjusted hazard ratios (HR), predominantly for clinical variables, were extracted for SIS, obstructive CAD, Agatston coronary artery calcium score, and plaque composition. These were pooled using DerSimonian-Laird random effects models. Results Eleven nonrandomized studies with good methodological quality enrolling 9777 subjects (mean age 61 ± 11 years, 57% male, mean follow up 3.3 years) who had 472 (4.8%) MACE (cardiac or all cause death, non-fatal myocardial infarction or late revascularization), were included. SIS (per segment increase) had pooled HR of 1.25 (95% CI: 1.16,1.35; I2 = 71.4%, p < 0.001) for MACE. HR for MACE was 1.37 (95% CI: 1.32,1.42; I2 = 95.6%, p < 0.001) for number of segments with stenosis (per segment increase), 3.39 (95% CI: 1.65,6.99; I2 = 87.8%, p = 0.001) for obstructive CAD (binary variable) and 1.00 (95% CI: 1.00,1.01; I2 = 75.0%, p = 0.490) for Agatston score (per unit increase). HRs by plaque composition (calcified, non-calcified and mixed; per segment change) were 1.24 (95% CI: 1.10,1.39; I2 = 81.6%, p = 0.001), 1.20 (95% CI: 0.97,1.48; I2 = 92.9%, p = 0.093) and 1.27 (95% CI: 1.03,1.58; I2 = 89.8%, p = 0.029), respectively. Conclusion Despite heterogeneity in endpoints, extent of CAD as quantified by SIS on coronary CTA is a strong, independent predictor of cardiovascular events.

KW - Atherosclerosis

KW - Coronary

KW - Coronary computed tomography

KW - Prognosis

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