Evidence map›Paper›PMID 29121752›Full record

Observational studyInternational journal of cardiology2017

Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain.

Daniel O Bittner, Richard A P Takx, Pedro V Staziaki, Sumbal Janjua, Tomas G Neilan, Nandini M Meyersohn, Michael T Lu, Anand M Prabhakar, John T Nagurney, Udo Hoffmann and 1 more

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

Observational study in International journal of cardiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.3field-weighted citation impact, top 19% of its field
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

3 citing papers in PubMed, 11 citations in OpenAlex.

  1. Review
  2. Review
  3. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 3 countries.

Daniel O BittnerCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, University Hospital Erlangen, Germany. Electronic address: daniel.bittner@uk-erlangen.de.
Richard A P TakxCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Pedro V StaziakiCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Sumbal JanjuaCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Tomas G NeilanCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Nandini M MeyersohnCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Michael T LuCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Anand M PrabhakarCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
John T NagurneyDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Udo HoffmannCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Brian B GhoshhajraCardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Harvard University · USMassachusetts General Hospital · USUniversity Medical Center Utrecht · NL

Funding

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 HL076136
6 · The paper itself

Abstract

backgroundThe number of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) is substantial. We tested whether identification of coronary artery calcium (CAC) can improve the negative predictive value (NPV) of clinical risk assessment for ACS in patients with acute chest pain. METHODS AND

resultsWe included 826 consecutive patients (mean age: 53±11years; 42% female) without known coronary artery disease (CAD) or initially elevated serum biomarkers, whom underwent non-contrast CT, to assess the CAC score, and CT angiography (CTA), to detect coronary stenosis. We analyzed the diagnostic performance of CAC and the Thrombolysis In Myocardial Infarction (TIMI) risk score for our primary outcomes (ACS and obstructive CAD). No CAC was found in 54% (n=444) of all patients, 63% (n=524) had a TIMI score of 0 and 40% (n=328) had both. The prevalence of obstructive CAD was 16% for ≥50% stenosis and 8.7% for ≥70% stenosis. The incidence of ACS was 7.9%, (MI=11, UAP=54). The NPV of CAC=0 was 99.5% for ACS. The NPV of a combination of TIMI score=0 and no CAC was 89% for any CAD (any plaque or stenosis) and 99.7% for ≥50% stenosis. A 100% NPV was found for ≥70% stenosis and ACS, correctly identifying 328 (40%) patients.

conclusionsThe exclusion of CAC, in combination with clinical risk assessment, has high clinical value in patients with acute chest pain, as it identifies patients at low risk for ACS and obstructive CAD more accurately as compared to clinical risk assessment alone.

Indexed as

Acute DiseaseAdultAgedChest PainCoronary Artery DiseaseFemaleFollow-Up StudiesHumansMaleMiddle AgedMyocardial InfarctionRegistriesRisk AssessmentVascular CalcificationAcute chest painAcute coronary syndromeCoronary artery calciumCoronary CT angiographyTIMI risk score

Identifiers

PMID29121752
PMCPMC5939567
OpenAlexW2766159350

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.