TY - JOUR
T1 - Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium
T2 - Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study
AU - Cho, Iksung
AU - Chang, Hyuk Jae
AU - Hartaigh, Briain O.
AU - Shin, Sanghoon
AU - Sung, Ji Min
AU - Lin, Fay Y.
AU - Achenbach, Stephan
AU - Heo, Ran
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Callister, Tracy Q.
AU - Al-Mallah, Mouaz H.
AU - Cademartiri, Filippo
AU - Chinnaiyan, Kavitha
AU - Chow, Benjamin J.W.
AU - Dunning, Allison M.
AU - DeLago, Augustin
AU - Villines, Todd C.
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Leipsic, Jonathon
AU - Shaw, Leslee J.
AU - Kaufmann, Philipp A.
AU - Cury, Ricardo C.
AU - Feuchtner, Gudrun
AU - Kim, Yong Jin
AU - Maffei, Erica
AU - Raff, Gilbert
AU - Pontone, Gianluca
AU - Andreini, Daniele
AU - Min, James K.
N1 - Publisher Copyright:
© 2014 Published on behalf of the European Society of Cardiology.
PY - 2015/2/21
Y1 - 2015/2/21
N2 - 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) χ2, 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 (LRχ2, 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.
AB - 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) χ2, 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 (LRχ2, 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.
KW - Asymptomatic
KW - Coronary artery calcium scoring
KW - Coronary computed tomographic angiography
KW - Framingham risk score
KW - Prognostic
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U2 - 10.1093/eurheartj/ehu358
DO - 10.1093/eurheartj/ehu358
M3 - Article
C2 - 25205531
AN - SCOPUS:84924590174
SN - 0195-668X
VL - 36
SP - 501
EP - 508
JO - European heart journal
JF - European heart journal
IS - 8
ER -