Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study.
- Cho I Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
- Chang HJ Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea hjchang@yuhs.ac.
- Ó Hartaigh B Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
- Shin S Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea.
- Sung JM Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea.
- Lin FY Department of Medicine, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
- Achenbach S Department of Medicine, University of Erlangen, Erlangen, Germany.
- Heo R Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.
- Berman DS Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.
- Budoff MJ Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.
- Callister TQ Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
- Al-Mallah MH Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.
- Cademartiri F Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Chinnaiyan K William Beaumont Hospital, Royal Oaks, MI, USA.
- Chow BJ Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada.
- Dunning AM Duke Clinical Research Institute, Durham, NC, USA.
- DeLago A Capitol Cardiology Associates, Albany, NY, USA.
- Villines TC Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.
- Hadamitzky M Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
- Hausleiter J Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
- Leipsic J Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
- Shaw LJ Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
- Kaufmann PA University Hospital, Zurich, Switzerland.
- Cury RC Baptist Cardiac and Vascular Institute, Miami, FL, USA.
- Feuchtner G Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
- Kim YJ Seoul National University Hospital, Seoul, South Korea.
- Maffei E Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Raff G William Beaumont Hospital, Royal Oaks, MI, USA.
- Pontone G Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
- Andreini D Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
- Min JK Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
- 2014-09-11
Published in:
- European heart journal. - 2015
Asymptomatic
Coronary artery calcium scoring
Coronary computed tomographic angiography
Framingham risk score
Prognostic
Coronary Angiography
Coronary Stenosis
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction
Prognosis
Risk Assessment
Tomography, X-Ray Computed
Vascular Calcification
English
AIM
Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown.
METHODS AND RESULTS
From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels-as defined by the per-patient presence of a ≥50% luminal stenosis-was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ(2), C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ(2), 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS.
CONCLUSION
Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.
Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown.
METHODS AND RESULTS
From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels-as defined by the per-patient presence of a ≥50% luminal stenosis-was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ(2), C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ(2), 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS.
CONCLUSION
Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1093/eurheartj/ehu358
- PMID 25205531
- Persistent URL
- https://sonar.ch/global/documents/167934
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