Imperial College London
Portrait Picture

Dr Tarun K Mittal MD, FRCR, MSc, FSCCT

Faculty of Medicine, National Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
//

Contact

 

+44 (0)1895 828 609t.mittal

 
 
//

Location

 

Dept of Medical ImagingHarefield HospitalHarefield Hospital

//

Summary

 

Publications

Citation

BibTex format

@article{Mittal:2017:ehjci/jex037,
author = {Mittal, TK and Pottle, A and Nicol, E and Barbir, M and Ariff, B and Mirsadraee, S and Dubowitz, M and Gorog, DA and Clifford, P and Firoozan, S and Smith, R and Dubrey, S and Chana, H and Shah, J and Stephens, N and Travill, C and Kelion, A and Pakkal, M and Timmis, A},
doi = {ehjci/jex037},
journal = {EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging},
pages = {922--929},
title = {Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score},
url = {http://dx.doi.org/10.1093/ehjci/jex037},
volume = {18},
year = {2017}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Aims:CT calcium scoring (CTCS) and CT cardiac angiography (CTCA) are widely used in patients with stable chest pain to exclude significant coronary artery disease (CAD). We aimed to resolve uncertainty about the prevalence of obstructive coronary artery disease and long-term outcomes in patients with a zero-calcium score (ZCS).Methods and results:Consecutive patients with stable cardiac symptoms referred for CTCS or CTCS and CTCA from chest pain clinics to a tertiary cardiothoracic centre were prospectively enrolled. In those with a ZCS, the prevalence of obstructive CAD on CTCA was determined. A follow-up for all-cause mortality was obtained from the NHS tracer service. A total of 3914 patients underwent CTCS of whom 2730 (69.7%) also had a CTCA. Half of the patients were men (50.3%) with a mean age of 56.9 years. Among patients who had both procedures, a ZCS was present in 52.2%, with a negative predictive value of 99.5% for excluding ≥70% stenosis on CTCA. During a mean follow-up of 5.2 years, the annual event rate was 0.3% for those with ZCS compared with 1.2% for CS ≥1. The presence of non-calcified atheroma on CTCA in patients with ZCS did not affect the prognostic value (P = 0.98).Conclusion:In patients with stable symptoms and a ZCS, obstructive CAD is rare, and prognosis over the long-term is excellent, regardless of whether non-calcified atheroma is identified. A ZCS could reliably be used as a ‘gatekeeper’ in this patient cohort, obviating the need for further more expensive tests.
AU  - Mittal,TK
AU  - Pottle,A
AU  - Nicol,E
AU  - Barbir,M
AU  - Ariff,B
AU  - Mirsadraee,S
AU  - Dubowitz,M
AU  - Gorog,DA
AU  - Clifford,P
AU  - Firoozan,S
AU  - Smith,R
AU  - Dubrey,S
AU  - Chana,H
AU  - Shah,J
AU  - Stephens,N
AU  - Travill,C
AU  - Kelion,A
AU  - Pakkal,M
AU  - Timmis,A
DO  - ehjci/jex037
EP  - 929
PY  - 2017///
SN  - 2047-2412
SP  - 922
TI  - Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score
T2  - EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
UR  - http://dx.doi.org/10.1093/ehjci/jex037
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000408086000016&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/58059
VL  - 18
ER  -
Download