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Coronary Artery Disease: HELP
Articles by Gary Small
Based on 5 articles published since 2010
(Why 5 articles?)
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Between 2010 and 2020, Gary Small wrote the following 5 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Determining patient prognosis using computed tomography coronary angiography. 2011

Kazmi, Mustapha H / Small, Gary / Sleiman, Lyne / Chow, Benjamin J W. ·University of Ottawa Heart Institute, Division of Cardiology, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada. ·Expert Rev Med Devices · Pubmed #22026629.

ABSTRACT: In addition to demonstrating luminal narrowings, cardiac computed tomography angiography (CTA) has the ability to detect nonstenotic plaque, vessel wall calcification and can assess left ventricular function. CTA prognostic studies have considered these components individually and in combination to produce novel risk factor scores to help predict clinical outcomes. In this article, we will consider the utility of CTA to predict clinical risk by considering the evidence for luminal stenosis, plaque scores, plaque descriptors and models combining these elements. We will also discuss some of the emerging applications of CTA that will likely provide future prognostic data in coronary artery disease patients. Although initially described as an anatomical investigation to determine the presence of coronary disease, CTA is being explored as a tool for functional imaging and may soon provide a noninvasive technique of anatomical and functional assessment previously only possible by invasive methods.

2 Article Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry) registry. 2015

Chow, Benjamin J W / Small, Gary / Yam, Yeung / Chen, Li / McPherson, Ruth / Achenbach, Stephan / Al-Mallah, Mouaz / Berman, Daniel S / Budoff, Matthew J / Cademartiri, Filippo / Callister, Tracy Q / Chang, Hyuk-Jae / Cheng, Victor Y / Chinnaiyan, Kavitha / Cury, Ricardo / Delago, Augustin / Dunning, Allison / Feuchtner, Gundrun / Hadamitzky, Martin / Hausleiter, Jörg / Karlsberg, Ronald P / Kaufmann, Philipp A / Kim, Yong-Jin / Leipsic, Jonathon / LaBounty, Troy / Lin, Fay / Maffei, Erica / Raff, Gilbert L / Shaw, Leslee J / Villines, Todd C / Min, James K / Anonymous5990820. ·From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C., R.M.) · Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.) · Department of Medicine, Henry Ford Hospital, Wayne State University, Detroit, MI (M.A.-M.) · Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.Y.C., T.L.) · Department of Medicine, Harbor University of California, Los Angeles Medical Center (M.J.B.) · Department of Radiology, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M.) · Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.) · Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.) · Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea (H.-J.C.) · William Beaumont Hospital, Royal Oaks, MI (K.C.) · Baptist Cardiac and Vascular Institute, Miami, FL (R.C.) · Capitol Cardiology Associates, Albany, NY (A.D.) · Department of Public Health (A.D.), Medicine and Radiology (F.L.), and Department of Radiology (J.K.M.), New York Presbyterian Hospital and the Weill Cornell Medical College · Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.) · Division of Cardiology, Technische Universität München, Munich, Germany (M.H., J.H.) · Cardiovascular Medical Group, Los Angeles, CA (R.P.K.) · Cardiac Imaging, University Hospital, Zurich, Switzerland (P.A.K.) · Seoul National University Hospital, Seoul, South Korea (Y.-J.K.) · Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.L.) · Department of Cardiology, William Beaumont Hospital, Royal Oaks, MI (G.L.R.) · Department of Medicine, Emory University School of Medicine, Atlanta, GA (L.J.S.) · and Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.). ·Arterioscler Thromb Vasc Biol · Pubmed #25676000.

ABSTRACT: OBJECTIVE: We sought to examine the risk of mortality associated with nonobstructive coronary artery disease (CAD) and to determine the impact of baseline statin and aspirin use on mortality. APPROACH AND RESULTS: Coronary computed tomographic angiography permits direct visualization of nonobstructive CAD. To date, the prognostic implications of nonobstructive CAD and the potential benefit of directing therapy based on nonobstructive CAD have not been carefully examined. A total of 27 125 consecutive patients who underwent computed tomographic angiography (12 enrolling centers and 6 countries) were prospectively entered into the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry. Patients, without history of previous CAD or obstructive CAD, for whom baseline statin and aspirin use was available were analyzed. Each coronary segment was classified as normal or nonobstructive CAD (1%-49% stenosis). Patients were followed up for a median of 27.2 months for all-cause mortality. The study comprised 10 418 patients (5712 normal and 4706 with nonobstructive CAD). In multivariable analyses, patients with nonobstructive CAD had a 6% (95% confidence interval, 1%-12%) higher risk of mortality for each additional segment with nonobstructive plaque (P=0.021). Baseline statin use was associated with a reduced risk of mortality (hazard ratio, 0.44; 95% confidence interval, 0.28-0.68; P=0.0003), a benefit that was present for individuals with nonobstructive CAD (hazard ratio, 0.32; 95% confidence interval, 0.19-0.55; P<0.001) but not for those without plaque (hazard ratio, 0.66; 95% confidence interval, 0.30-1.43; P=0.287). When stratified by National Cholesterol Education Program/Adult Treatment Program III, no mortality benefit was observed in individuals without plaque. Aspirin use was not associated with mortality benefit, irrespective of the status of plaque. CONCLUSIONS: The presence and extent of nonobstructive CAD predicted mortality. Baseline statin therapy was associated with a significant reduction in mortality for individuals with nonobstructive CAD but not for individuals without CAD. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/. Unique identifier NCT01443637.

3 Article A single slice measure of epicardial adipose tissue can serve as an indirect measure of total epicardial adipose tissue burden and is associated with obstructive coronary artery disease. 2014

Tran, Thomas / Small, Gary / Cocker, Myra / Yam, Yeung / Chow, Benjamin J W. ·Department of Medicine (Cardiology), University of Ottawa Heart Institute, The Ottawa Hospital, 40 Ruskin Street, Ottawa, ON, Canada K1Y 4W7. ·Eur Heart J Cardiovasc Imaging · Pubmed #24107904.

ABSTRACT: AIMS: To evaluate the practical use of the single slice measurement of epicardial adipose tissue (EAT) at the level of the left main coronary artery (EATLM) in predicting the presence of obstructive coronary artery disease (CAD). METHODS AND RESULTS: Quantification of EATTotal and EATLM was performed on non-contrast CT scans of consecutive patients (without history of revascularization, cardiac transplantation, device implantation, and congenital heart disease) who underwent coronary artery calcium (CAC) scoring and computed tomographic coronary angiography (CTA) between May 2011 and July 2011. One hundred and ninety-two patients were evaluated, of which 47 had obstructive CAD (>50% stenosis). EATLM (3.8 ± 2.2 cm(3)) and EATTotal (126.2 ± 56.3 cm(3)) are highly correlated (r = 0.89, P < 0.001). Multivariate analysis revealed that both EATLM (OR: 1.204 per 1 cm(3), 95% CI: 1.028-1.411, P = 0.021) and EATTotal (OR: 1.007 per 10 cm(3), 95% CI: 1.000-1.013, P = 0.038) are associated with obstructive CAD. However, when the CAC score was added to multivariate analysis, both failed to show statistical significance. (EATTotal, OR 1.004 per 1 cm(3), 95% CI: 0.996-1.011, P = 0.328 and EATLM, OR: 1.136 per 10 cm(3), 95% CI: 0.948-1.362) ROC curve analysis revealed that both EATTotal and EATLM are of incremental value in detecting CAD, when compared with clinical risk scores (NCEP plus EATTotal plus BMI and NCEP plus EATLM plus BMI vs. NCEP alone; AUC 0.7090, P = 0.009 and 0.7167, P = 0.003 vs. 0.6069, respectively). CONCLUSION: Measuring epicardial adipose tissue on a single slice at the level of the left main coronary artery may serve as an indirect measure of total epicardial adipose tissue burden. EATLM and EATTotal are independently associated with obstructive coronary artery disease and are incremental to traditional risk factors for predicting its presence.

4 Article Incremental prognostic value of cardiac computed tomography in coronary artery disease using CONFIRM: COroNary computed tomography angiography evaluation for clinical outcomes: an InteRnational Multicenter registry. 2011

Chow, Benjamin J W / Small, Gary / Yam, Yeung / Chen, Li / Achenbach, Stephan / Al-Mallah, Mouaz / Berman, Daniel S / Budoff, Matthew J / Cademartiri, Filippo / Callister, Tracy Q / Chang, Hyuk-Jae / Cheng, Victor / Chinnaiyan, Kavitha M / Delago, Augustin / Dunning, Allison / Hadamitzky, Martin / Hausleiter, Jörg / Kaufmann, Philipp / Lin, Fay / Maffei, Erica / Raff, Gilbert L / Shaw, Leslee J / Villines, Todd C / Min, James K / Anonymous3260699. ·Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada. bchow@ottawaheart.ca ·Circ Cardiovasc Imaging · Pubmed #21730027.

ABSTRACT: BACKGROUND: Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables. METHODS AND RESULTS: A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non-high-risk, or high-risk CAD) and LVEF <50%. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3%) patients (mean follow-up of 22.5 months; 95% confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65% of patients without coronary atherosclerosis, 1.99% of patients with nonobstructive CAD, 2.90% of patients with non-high-risk CAD, and 4.95% for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50% (hazard ratio, 2.74; 95% confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95% confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables. CONCLUSIONS: Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.

5 Article Prognostic value of CT angiography in coronary bypass patients. 2011

Chow, Benjamin J W / Ahmed, Osman / Small, Gary / Alghamdi, Abdul-Aziz / Yam, Yeung / Chen, Li / Wells, George A. ·Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. bchow@ottawaheart.ca ·JACC Cardiovasc Imaging · Pubmed #21565737.

ABSTRACT: OBJECTIVES: We sought the incremental prognostic value of coronary computed tomography angiography (CTA) in coronary artery bypass graft (CABG) patients. BACKGROUND: Coronary CTA is a noninvasive and accurate tool for the detection of obstructive coronary artery disease, and coronary CTA appears to have prognostic value in patients without previous revascularization. However, the prognostic value of coronary CTA to predict major adverse cardiac events in CABG patients is unclear. METHODS: Consecutive CABG patients were prospectively enrolled and cardiac risk was calculated using the National Cholesterol Evaluation Program/Adult Treatment Panel III. Using the severity of native coronary artery disease and graft disease, the number of unprotected coronary territories (UCTs) (0, 1, 2, or 3) was calculated. Patients were followed for cardiac death and nonfatal myocardial infarction. All events were confirmed with death certificates or medical records and reviewed by a clinical events committee. RESULTS: Between February 2006 and March 2009, 250 consecutive patients were enrolled and followed for a mean of 20.8 ± 10.1 months. At follow-up, 23 patients (9.2%) had major adverse cardiac events (15 cardiac deaths and 8 nonfatal MI). The absence of UCTs conferred a good prognosis with an annual event rate of 2.4%. Conversely, patients with 1, 2, and 3 UCTs had annualized event rates of 5.8%, 11.1%, and 21.7%, respectively. Multivariable analysis showed that UCTs (hazard ratio: 2.08; 95% confidence interval: 1.40 to 3.10; p < 0.001) was a predictor of major adverse cardiac events when adjusted for clinical variables. Examining the receiver-operator characteristic curves, the area under the curve increased from 0.61 to 0.76 when UCTs was combined with clinical variables (p = 0.001). CONCLUSIONS: Assessing UCTs with coronary CTA appears to have prognostic value in CABG patients and is incremental to clinical variables. Coronary CTA appears to be a promising tool for risk stratification of CABG patients. Further multicenter studies using large CABG cohorts are needed to confirm our findings.