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dc.contributor.authorYoon, Sung Hyun
dc.contributor.authorKim, Eunhee
dc.contributor.authorJeon, Yongho
dc.contributor.authorYi, Sang Yoon
dc.contributor.authorBae, Hee-Joon
dc.contributor.authorJang, Ik-Kyung
dc.contributor.authorLee, Joo Myung
dc.contributor.authorYoo, Seung Min
dc.contributor.authorWhite, Charles S.
dc.contributor.authorChun, Eun Ju
dc.description.abstractObjective: To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison to a clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemic stroke patients without chest pain. Materials and Methods: This retrospective study included 1418 patients with acute stroke who had no previous cardiac disease and underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) were assessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed: low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognostic value of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. Results: The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%, respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS, and stenosis degree were positively associated with MACE (all p < 0.05). Patients with high-risk plaque type showed the highest incidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p < 0.001). Among the prediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared to FRS or the FRS + CACS model (all p < 0.05). Furthermore, incorporating plaque type in the prediction model significantly improved reclassification (integrated discrimination improvement, 0.08; p = 0.023) and showed the highest discrimination index (C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p > 0.05). Conclusion: Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS and FRS to risk stratify stroke patients without prior history of CAD better.en_US
dc.description.sponsorshipSeoul National University Bundang Hospitalen_US
dc.publisherThe Korean Society of Radiologyen_US
dc.relation.ispartofKorean Journal of Radiologyen_US
dc.subjectRadiology Nuclear Medicine and imagingen_US
dc.subjectCoronary artery calcium scoringen_US
dc.subjectCoronary computed tomography angiographyen_US
dc.subjectCoronary stenosisen_US
dc.subjectPlaque, atheroscleroticen_US
dc.titlePrognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients without Known Cardiac Disease or Chest Pain: The Assessment of Coronary Artery Disease in Stroke Patients Studyen_US

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