Evidence map›Paper›PMID 25899714›Full record

ArticleEuropean heart journal. Cardiovascular Imaging2015

Prognostic value of coronary CTA vs. exercise treadmill testing: results from the Partners registry.

Michael K Cheezum, Prem Srinivas Subramaniyam, Marcio S Bittencourt, Edward A Hulten, Brian B Ghoshhajra, Nishant R Shah, Daniel E Forman, Jon Hainer, Marcia Leavitt, Ram Padmanabhan and 7 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal. Cardiovascular Imaging, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Review
  5. Review
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Michael K CheezumNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA.
Prem Srinivas SubramaniyamDepartment of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Marcio S BittencourtNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil.
Edward A HultenNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA.
Brian B GhoshhajraDepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Nishant R ShahNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA.
Daniel E FormanNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA.
Jon HainerNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA.
Marcia LeavittDepartment of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ram PadmanabhanDepartment of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Hicham SkaliNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA.
Sharmila DorbalaNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA.
Udo HoffmannDepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Suhny AbbaraDepartment of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Marcelo F Di CarliNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA.
Henry GewirtzDepartment of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ron BlanksteinNon-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Shapiro Room 5096, Boston, MA 02115, USA rblankstein@partners.org.

Funding

Noninvasive Cardiovascular Imaging Research Training ProgramT32HL094301 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI Marcelo F DI CARLI · 2010 to 2026
$7.8M
Cardiac MR and CT ResearchT32HL076136 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NEILAN, TOMAS G · 2004 to 2019
$4.9M
Cardiovascular Imaging in Ischemic Heart DiseaseK24HL113128 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2012 to 2020
$1.1M
NHLBI NIH HHS K24 HL113128NHLBI NIH HHS T32 HL076136NHLBI NIH HHS T32 HL094301
6 · The paper itself

Abstract

aimsWe sought to compare the complementary prognostic value of exercise treadmill testing (ETT) and coronary computed tomographic angiography (CTA) among patients referred for both exams. METHODS AND

resultsWe studied 582 patients without known coronary artery disease (CAD) who were clinically referred for ETT and CTA within 6 months. Patients were followed for cardiovascular (CV) death, non-fatal myocardial infarction (MI), or late revascularization (>90 days), stratified by Duke Treadmill Score (DTS) and CAD severity (≥50% stenosis). Mean age was 54 ± 13 years (63% male). In median follow-up of 40 months, there were 3 CV deaths, 7 non-fatal MIs, and 26 late revascularizations. ETT was inconclusive in 23%, positive in 31%, and negative in 46%. CTA demonstrated no CAD in 37%, non-obstructive CAD in 28%, and obstructive CAD in 35%. Among low-risk ETT patients (n = 326), there were 3 MI, 10 late revascularizations, and the frequent presence of non-obstructive (32%, n = 105) and obstructive CAD (27%, n = 88). When present, ETT features (i.e., angina, DTS, ischaemic electrocardiogram changes, and exercise capacity) individually failed to predict CV death/MI after adjustment for Morise score. Conversely, both obstructive CAD [HR 4.9 (1.0-23.3), P = 0.048] and CAD extent by segment involvement score >4 [HR 3.9 (1.0-15.2), P = 0.049] predicted increased risk for CV death or MI.

conclusionPatients with a low-risk ETT have an excellent prognosis at 40 months, despite the frequent presence of non-obstructive (32%) and obstructive (27%) CAD. In patients with an intermediate- to high-risk ETT (DTS <5), CTA can provide incremental risk stratification for future CV events.

Indexed as

Coronary AngiographyExercise TestTomography, X-Ray ComputedCoronary DiseaseFemaleHumansMaleMassachusettsMiddle AgedPrognosisRegistriesRisk AssessmentRisk FactorsSurvival Analysiscoronary artery diseasecoronary computed tomographic angiographyexercise testingmajor adverse cardiac eventsprognosis

Identifiers

PMID25899714
PMCPMC4668770

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.