Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: a 6-year follow-up from the prospective multicentre international CONFIRM study

Cho I, Al'Aref SJ, Berger A, Hartaigh BO, Gransar H, Valenti V, Lin FY, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Delago A, Villines TC, Hadamitzky M, Hausleiter J, Leipsic J, Shaw LJ, Kaufmann PA, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Marques H, Rubinshtein R, Chang HJ, Min JK (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Book Volume: 39

Pages Range: 934-941

Journal Issue: 11

DOI: 10.1093/eurheartj/ehx774

Abstract

Aim: The long-term prognostic benefit of coronary computed tomographic angiography (CCTA) findings of coronary artery disease (CAD) in asymptomatic populations is unknown. Methods and results: From the prospective multicentre international CONFIRM long-term study, we evaluated asymptomatic subjects without known CAD who underwent both coronary artery calcium scoring (CACS) and CCTA (n = 1226). Coronary computed tomographic angiography findings included the severity of coronary artery stenosis, plaque composition, and coronary segment location. Using the C-statistic and likelihood ratio tests, we evaluated the incremental prognostic utility of CCTA findings over a base model that included a panel of traditional risk factors (RFs) as well as CACS to predict long-term all-cause mortality. During a mean follow-up of 5.9 ± 1.2 years, 78 deaths occurred. Compared with the traditional RF alone (C-statistic 0.64), CCTA findings including coronary stenosis severity, plaque composition, and coronary segment location demonstrated improved incremental prognostic utility beyond traditional RF alone (C-statistics range 0.71-0.73, all P < 0.05; incremental χ2 range 20.7-25.5, all P < 0.001). However, no added prognostic benefit was offered by CCTA findings when added to a base model containing both traditional RF and CACS (C-statistics P > 0.05, for all). Conclusions: Coronary computed tomographic angiography improved prognostication of 6-year all-cause mortality beyond a set of conventional RF alone, although, no further incremental value was offered by CCTA when CCTA findings were added to a model incorporating RF and CACS.

Involved external institutions

Cornell University United States (USA) (US) Università degli studi di Milano Italy (IT) King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) / جامعة الملك سعود بن عبد العزيز للعلوم الصحية Saudi Arabia (SA) Université de Montréal Canada (CA) Tennessee Heart & Vascular United States (USA) (US) University of Ottawa Canada (CA) Ludwig-Maximilians-Universität (LMU) Germany (DE) Walter Reed Army Medical Center (WRAMC) United States (USA) (US) Hospital da Luz Portugal (PT) Emory University United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Medizinische Universität Innsbruck Austria (AT) Universitätsspital Zürich (USZ) Switzerland (CH) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Technion - Israel Institute of Technology Israel (IL) Deutsches Herzzentrum München Germany (DE) Yonsei University Health System (YUHS) Korea, Republic of (KR) Beaumont Health System United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Harbor–UCLA Medical Center United States (USA) (US) University of British Columbia Canada (CA)

How to cite

APA:

Cho, I., Al'Aref, S.J., Berger, A., Hartaigh, B.O., Gransar, H., Valenti, V.,... Min, J.K. (2018). Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: a 6-year follow-up from the prospective multicentre international CONFIRM study. European Heart Journal, 39(11), 934-941. https://dx.doi.org/10.1093/eurheartj/ehx774

MLA:

Cho, Iksung, et al. "Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: a 6-year follow-up from the prospective multicentre international CONFIRM study." European Heart Journal 39.11 (2018): 934-941.

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