TY - JOUR
T1 - Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors
T2 - Results from the 5 year follow-up of the CONFIRM International Multicenter Registry
AU - Cheruvu, Chaitu
AU - Precious, Bruce
AU - Naoum, Christopher
AU - Blanke, Philipp
AU - Ahmadi, Amir
AU - Soon, Jeanette
AU - Arepalli, Chesnaldey
AU - Gransar, Heidi
AU - Achenbach, Stephan
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Callister, Tracy Q.
AU - Al-Mallah, Mouaz H.
AU - Cademartiri, Filippo
AU - Chinnaiyan, Kavitha
AU - Rubinshtein, Ronen
AU - Marquez, Hugo
AU - DeLago, Augustin
AU - Villines, Todd C.
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
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 - Chang, Hyuk Jae
AU - Min, James K.
AU - Leipsic, Jonathon
N1 - Publisher Copyright:
© 2016 Society of Cardiovascular Computed Tomography.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background: Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE). Objective: Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE. Methods: From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days). Results: Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend. Conclusions: In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period.
AB - Background: Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE). Objective: Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE. Methods: From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days). Results: Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend. Conclusions: In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period.
KW - All-cause mortality
KW - Coronary artery disease
KW - Coronary computed tomographic angiography
KW - Major adverse cardiovascular events
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U2 - 10.1016/j.jcct.2015.12.005
DO - 10.1016/j.jcct.2015.12.005
M3 - Article
C2 - 26719237
AN - SCOPUS:84958919087
SN - 1934-5925
VL - 10
SP - 22
EP - 27
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 1
ER -