Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) st

Cho I, Chang HJ, Hartaigh BO, Shin S, Sung JM, Lin FY, Achenbach S, Heo R, Berman DS, Budoff MJ, Callister T, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Dunning AM, Delago A, Villines TC, Hadamitzky M, Hausleiter J, Leipsic J, Shaw LJ, Kaufmann PA, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Min JK (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Book Volume: 36

Pages Range: 501-8

Journal Issue: 8

DOI: 10.1093/eurheartj/ehu358

Abstract

Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown.From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels-as defined by the per-patient presence of a >=50% luminal stenosis-was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) ?(2), C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LR?(2), 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS <=100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS.Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.

Authors with CRIS profile

Involved external institutions

New York Presbyterian Hospital United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Yonsei University Health System (YUHS) Korea, Republic of (KR) Università degli studi di Milano Italy (IT) Beaumont Health System United States (USA) (US) Casa di Cura Giovanni XXIII Italy (IT) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Medizinische Universität Innsbruck Austria (AT) Baptist Health South Florida United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH) Emory University United States (USA) (US) University of British Columbia Canada (CA) Ludwig-Maximilians-Universität (LMU) Germany (DE) Deutsches Herzzentrum München Germany (DE) Walter Reed Army Medical Center (WRAMC) United States (USA) (US) Duke University Medical Center United States (USA) (US) University of Ottawa Canada (CA) Wayne State University (WSU) United States (USA) (US) Tennessee Heart & Vascular United States (USA) (US) University of California Los Angeles (UCLA) United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Cornell University United States (USA) (US)

How to cite

APA:

Cho, I., Chang, H.-J., Hartaigh, B.O., Shin, S., Sung, J.M., Lin, F.Y.,... Min, J.K. (2015). Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) st. European Heart Journal, 36(8), 501-8. https://doi.org/10.1093/eurheartj/ehu358

MLA:

Cho, Iksung, et al. "Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) st." European Heart Journal 36.8 (2015): 501-8.

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