Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals

Min JK, Labounty TM, Gomez MJ, Achenbach S, Al-Mallah M, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, Chinnaiyan KM, Chowk B, Cury R, Delago A, Dunning A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann P, Kim YJ, Leipsic J, Lin FY, Maffei E, Raff G, Shaw LJ, Villines TC, Berman DS (2014)

Publication Type: Journal article

Publication year: 2014

Journal

Publisher: Elsevier

Book Volume: 232

Pages Range: 298-304

Journal Issue: 2

DOI: 10.1016/j.atherosclerosis.2013.09.025

Abstract

Coronary artery disease (CAD) diagnosis by coronary computed tomographic angiography (CCTA) is useful for identification of symptomatic diabetic individuals at heightened risk for death. Whether CCTA-detected CAD enables improved risk assessment of asymptomatic diabetic individuals beyond clinical risk factors and coronary artery calcium scoring (CACS) remains unexplored.From a prospective 12-center international registry of 27,125 individuals undergoing CCTA, we identified 400 asymptomatic diabetic individuals without known CAD. Coronary stenosis by CCTA was graded as 0%, 1-49%, 50-69%, and >=70%. CAD was judged on a per-patient, per-vessel and per-segment basis as maximal stenosis severity, number of vessels with >=50% stenosis, and coronary segments weighted for stenosis severity (segment stenosis score), respectively. We assessed major adverse cardiovascular events (MACE) - inclusive of mortality, nonfatal myocardial infarction (MI), and late target vessel revascularization >=90 days (REV) - and evaluated the incremental utility of CCTA for risk prediction, discrimination and reclassification.Mean age was 60.4 ± 9.9 years; 65.0% were male. At a mean follow-up 2.4 ± 1.1 years, 33 MACE occurred (13 deaths, 8 MI, 12 REV) [8.25%; annualized rate 3.4%]. By univariate analysis, per-patient maximal stenosis [hazards ratio (HR) 2.24 per stenosis grade, 95% confidence interval (CI) 1.61-3.10, p < 0.001], increasing numbers of obstructive vessels (HR 2.30 per vessel, 95% CI 1.75-3.03, p < 0.001) and segment stenosis score (HR 1.14 per segment, 95% CI 1.09-1.19, p < 0.001) were associated with increased MACE. After adjustment for CAD risk factors and CACS, maximal stenosis (HR 1.80 per grade, 95% CI 1.18-2.75, p = 0.006), number of obstructive vessels (HR 1.85 per vessel, 95% CI 1.29-2.65, p < 0.001) and segment stenosis score (HR 1.11 per segment, 95% CI 1.05-1.18, p < 0.001) were associated with increased risk of MACE. Beyond age, gender and CACS (C-index 0.64), CCTA improved discrimination by maximal stenosis, number of obstructive vessels and segment stenosis score (C-index 0.77, 0.77 and 0.78, respectively). Similarly, CCTA findings improved risk reclassification by per-patient maximal stenosis [integrated discrimination improvement (IDI) index 0.03, p = 0.03] and number of obstructive vessels (IDI index 0.06, p = 0.002), and by trend for segment stenosis score (IDI 0.03, p = 0.06).For asymptomatic diabetic individuals, CCTA measures of CAD severity confer incremental risk prediction, discrimination and reclassification on a per-patient, per-vessel and per-segment basis.

Authors with CRIS profile

Involved external institutions

Cornell University United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Wayne State University (WSU) United States (USA) (US) Harbor–UCLA Medical Center United States (USA) (US) Casa di Cura Giovanni XXIII Italy (IT) Tennessee Heart & Vascular United States (USA) (US) Yonsei University Health System (YUHS) Korea, Republic of (KR) Beaumont Health System United States (USA) (US) University of Ottawa Canada (CA) Baptist Health South Florida United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Medizinische Universität Innsbruck Austria (AT) Ludwig-Maximilians-Universität (LMU) Germany (DE) Cardiovascular Medical Group of Southern California United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) University of British Columbia Canada (CA) Emory University United States (USA) (US) Walter Reed Army Medical Center (WRAMC) United States (USA) (US)

How to cite

APA:

Min, J.K., Labounty, T.M., Gomez, M.J., Achenbach, S., Al-Mallah, M., Budoff, M.J.,... Berman, D.S. (2014). Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals. Atherosclerosis, 232(2), 298-304. https://doi.org/10.1016/j.atherosclerosis.2013.09.025

MLA:

Min, James K., et al. "Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals." Atherosclerosis 232.2 (2014): 298-304.

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