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

Han D, Hartaigh BO, Gransar H, Lee JH, Rizvi A, Baskaran L, Schulman-Marcus J, Dunning A, Achenbach S, Al-Mallah MH, Berman DS, Budoff MJ, Cademartiri F, Maffei E, Callister TQ, Chinnaiyan K, Chow BJW, Delago A, Hadamitzky M, Hausleiter J, Kaufmann PA, Raff G, Shaw LJ, Villines TC, Kim YJ, Leipsic J, Feuchtner G, Cury RC, Pontone G, Andreini D, Marques H, Rubinshtein R, Hindoyan N, Jones EC, Gomez M, Lin FY, Chang HJ, Min JK (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Book Volume: 19

Pages Range: 675-683

Journal Issue: 6

DOI: 10.1093/ehjci/jex150

Abstract

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.

Authors with CRIS profile

Involved external institutions

Duke University Medical Center United States (USA) (US) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Beaumont Health System United States (USA) (US) King Abdullah International Medical Research Center (KAIMRC) Saudi Arabia (SA) Walter Reed Army Medical Center (WRAMC) United States (USA) (US) Istituto di ricovero e cura a carattere scientifico (IRCCS) Italy (IT) Tennessee Heart & Vascular United States (USA) (US) University of British Columbia Canada (CA) Cedars-Sinai Medical Center United States (USA) (US) New York Presbyterian Hospital United States (USA) (US) Baptist Health South Florida United States (USA) (US) Emory University United States (USA) (US) Ospedale Civile di Urbino Italy (IT) Medizinische Universität Innsbruck Austria (AT) Universitätsspital Zürich (USZ) Switzerland (CH) Ludwig-Maximilians-Universität (LMU) Germany (DE) Albany Medical Center United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Yonsei University Korea, Republic of (KR) SDN Istituto di Ricerca Diagnostica e Nucleare Italy (IT) Hospital da Luz Portugal (PT) Deutsches Herzzentrum München Germany (DE) University of Ottawa Canada (CA) Technion - Israel Institute of Technology Israel (IL) Harbor–UCLA Medical Center United States (USA) (US)

How to cite

APA:

Han, D., Hartaigh, B.O., Gransar, H., Lee, J.H., Rizvi, A., Baskaran, L.,... Min, J.K. (2018). Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. European Heart Journal - Cardiovascular Imaging, 19(6), 675-683. https://dx.doi.org/10.1093/ehjci/jex150

MLA:

Han, Donghee, et al. "Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals." European Heart Journal - Cardiovascular Imaging 19.6 (2018): 675-683.

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