Evidence map›Paper›PMID 37582155›Full record

ArticleCirculation. Cardiovascular imaging2023

Interplay Between Zero CAC, Quantitative Plaque Analysis, and Adverse Events in a Diverse Patient Cohort.

Michael Fattouh, Toshiki Kuno, Pamela Pina, John P Skendelas, Daniel Lorenzatti, Javier Arce, Jonathan Daich, Gustavo Duarte, Carol Fernandez-Hazim, Miguel Rodriguez-Guerra and 12 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Cardiovascular imaging, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.1field-weighted citation impact, top 13% 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

4 citing papers in PubMed, 9 citations in OpenAlex.

  1. Observational
  2. Article
  3. Review
  4. Article
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

22 authors at 5 institutions in 2 countries.

Michael Fattouh *Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Toshiki Kuno *Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).ORCID 0000-0002-2487-8366
Pamela PinaDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).ORCID 0000-0002-5404-4389
John P SkendelasCardiothoracic and Vascular Surgery Department, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (J.P.S.).
Daniel LorenzattiDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Javier ArceDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Jonathan DaichDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).ORCID 0000-0002-2064-6437
Gustavo DuarteDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Carol Fernandez-HazimDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).ORCID 0009-0002-2637-1179
Miguel Rodriguez-GuerraDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).ORCID 0000-0002-7047-6077
Patrick NeshiwatDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).ORCID 0009-0003-9353-7359
Aldo L SchenoneDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Lili ZhangDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Carlos J RodriguezDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Armin Arbab-ZadehDivision of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (A.A.-Z., M.J.B.).ORCID 0000-0003-2516-9083
Piotr J SlomkaDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA (P.J.S., D.S.B., D.D.).ORCID 0000-0002-6110-938X
Salim S ViraniSection of Cardiology, Department of Medicine, The Aga Khan Universit, Karachi, Pakistan (S.S.V.).ORCID 0000-0001-9541-6954
Michael J BlahaDivision of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (A.A.-Z., M.J.B.).ORCID 0000-0001-5138-9683
Daniel S BermanDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA (P.J.S., D.S.B., D.D.).
Damini DeyDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA (P.J.S., D.S.B., D.D.).ORCID 0000-0003-2236-6970
Mario J GarciaDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).
Leandro SlipczukDivision of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (M.F., T.K., P.P., D.L., J.A., J.D., G.D., C.F.-H., M.R.-G., P.N., A.L.S., L.Z., C.J.R., M.J.G., L.S.).ORCID 0000-0003-3091-3735
Jacobi Medical Center · USAlbert Einstein College of Medicine · USCedars-Sinai Medical Center · USJohns Hopkins University · USAga Khan University · PK

Funding

Sex differences in the role of multi-omics in HIV-associated carotid artery atherosclerosisU01HL146204 · NHLBI · ALBERT EINSTEIN COLLEGE OF MEDICINE · PI David B. Hanna, Anjali Sharma · 2019 to 2026
$33.2M
Research Training and Education Core (Core D) P50HL120163 · NHLBI · AMERICAN HEART ASSOCIATION · PI BHATNAGAR, ARUNI · 2013 to 2017
$20.1M
Non-alcoholic Fatty Liver Disease and Cardiovascular Disease in Hispanics/LatinosR01HL144707 · NHLBI · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI KIZER, JORGE R, LIMA, JOAO A C · 2019 to 2022
$9.3M
CTSA K12 Program at Einstein-MontefioreK12TR004411 · NCATS · ALBERT EINSTEIN COLLEGE OF MEDICINE · PI Deepa Rastogi · 2023 to 2026
$3.0M
Integrated prediction of cardiovascular events by automated coronary plaque and pericoronary adipose tissue quantification from CT AngiographyR01HL148787 · NHLBI · CEDARS-SINAI MEDICAL CENTER · PI DEY, DAMINI · 2020 to 2023
$3.0M
Effect of Intensive Medical Treatment on Quantified Coronary Artery Plaque Components with Serial Coronary CTA in Women with Non-Obstructive CADR01HL151266 · NHLBI · CEDARS-SINAI MEDICAL CENTER · PI DEY, DAMINI, TAMARAPPOO, BALAJI K. · 2020 to 2023
$1.6M
INTERGRATIVE CONTROL OF CARDIOVASCULAR FUNCTIONK02HL004199 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI PAN, HUI-LIN · 2000 to 2003
$367k
BIOLOGY OF PNEUMOCYSTIS IN VITRO AND IN VIVOZ01CL000011 · CLC · CLINICAL CENTER · PI MASUR, H · 1985 to 1987
–
CLC NIH HHS 75N90019D00011NCATS NIH HHS K12 TR004411NHLBI NIH HHS 75N92021D00011NHLBI NIH HHS K02 HL004199NHLBI NIH HHS P50 HL120163NHLBI NIH HHS R01 HL144707NHLBI NIH HHS R01 HL148787NHLBI NIH HHS R01 HL151266NHLBI NIH HHS U01 HL146204
6 · The paper itself

Abstract

backgroundCoronary artery calcium scoring (CAC) has garnered attention in the diagnostic approach to chest pain patients. However, little is known about the interplay between zero CAC, sex, race, ethnicity, and quantitative coronary plaque analysis.

methodsWe conducted a retrospective analysis from our computed tomography registry of patients with stable angina without prior myocardial infarction or revascularization undergoing coronary computed tomography angiography at Montefiore Healthcare System. Follow-up end points collected included invasive angiography, type-1 myocardial infarction, coronary revascularization, cardiovascular and all-cause death.

resultsA total of 2249 patients were included (66% female). The median follow-up was 5.5 years. The median age of those without CAC was 52 years (interquartile range, 44-59) and 60 years (interquartile range, 53-68) in those with CAC. Most patients were Hispanic (58%), and the rest were non-Hispanic Black (28%), non-Hispanic White (10%), and non-Hispanic Asian (5%). The majority had CAC=0 (55%). The negative predictive value of CAC=0 was 92.8%, 99.9%, and 99.9% for any plaque, obstructive coronary artery stenosis, and the composite outcome of all-cause death, myocardial infarction, or coronary revascularization, respectively. Among patients without CAC (n=1237), 89 patients (7%) had evidence of plaque on their coronary computed tomography angiography with a median low-attenuation noncalcified plaque burden of 4% (2-7). There were no significant differences in the negative predictive value for CAC=0 by sex, race, or ethnicity. Patients with ≥2 risk factors had higher odds of having plaque with zero CAC.

conclusionsIn summary, no sex, race, or ethnicity differences were demonstrated in the negative predictive value of a zero CAC; however, patients with ≥2 risk factors had a higher prevalence of plaque. A small percentage (7%) of symptomatic patients undergoing coronary computed tomography angiography with zero CAC had noncalcified coronary plaque, with the implication that caution is needed for downscaling of preventive treatment in patients with zero CAC, chest pain, and multiple risk factors.

Indexed as

Coronary Artery DiseaseMyocardial InfarctionPlaque, AtheroscleroticAdultChest PainCoronary AngiographyFemaleHumansMaleMiddle AgedPredictive Value of TestsRetrospective StudiesRisk AssessmentRisk Factorscardiovascularchest paincoronary artery calcium scoreplaque analysispower of zero

Identifiers

PMID37582155
PMCPMC10430772
OpenAlexW4385739174

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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.