Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Donghee Han, Bríain Hartaigh, Heidi Gransar, Ji Hyun Lee, Asim Rizvi, Lohendran Baskaran, Joshua Schulman-Marcus, Allison Dunning, Stephan Achenbach, Mouaz H. Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Erica Maffei, Tracy Q. Callister, Kavitha Chinnaiyan, Benjamin J.W. Chow, Augustin Delago, Martin Hadamitzky, Joerg HausleiterPhilipp A. Kaufmann, Gilbert Raff, Leslee J. Shaw, Todd C. Villines, Yong Jin Kim, Jonathon Leipsic, Gudrun Feuchtner, Ricardo C. Cury, Gianluca Pontone, Daniele Andreini, Hugo Marques, Ronen Rubinshtein, Niree Hindoyan, Erica C. Jones, Millie Gomez, Fay Y. Lin, Hyuk Jae Chang, James K. Min

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Aims Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults. Methods and results Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles. Conclusion CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.

Original languageEnglish (US)
Pages (from-to)675-683
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number6
StatePublished - Jun 1 2018


  • coronary artery calcium score
  • coronary computed tomography angiography
  • elderly
  • risk assessment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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