Long-term prognostic utility of computed tomography coronary angiography in older populations

Gnanenthiran SR, Naoum C, Leipsic JA, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJ, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufman PA, Kim YJ, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Shaw LJ, Villines TC, Gransar H, Lu Y, Jones EC, Peña JM, Lin FY, Kritharides L, Min JK (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 20

Pages Range: 1279-1286

Journal Issue: 11

DOI: 10.1093/ehjci/jez067

Abstract

AIMS: The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations. METHODS AND RESULTS: From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: none, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD. CONCLUSION: The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.

Authors with CRIS profile

Involved external institutions

Beaumont Health United States (USA) (US) Tennessee Heart & Vascular United States (USA) (US) Walter Reed National Military Medical Center United States (USA) (US) New York Presbyterian Hospital United States (USA) (US) Technion - Israel Institute of Technology Israel (IL) SDN Istituto di Ricerca Diagnostica e Nucleare Italy (IT) Hospital da Luz Portugal (PT) Cedars-Sinai Medical Center United States (USA) (US) University of Zurich / Universität Zürich (UZH) Switzerland (CH) Yonsei University Health System (YUHS) Korea, Republic of (KR) University of Sydney (USYD) Australia (AU) University of Ottawa Canada (CA) Capitol Cardiology Associates United States (USA) (US) Medizinische Universität Innsbruck Austria (AT) Los Angeles Biomedical Research Institute (LA BioMed) United States (USA) (US) Università degli studi di Milano Italy (IT) Baptist Health South Florida United States (USA) (US) Deutsches Herzzentrum München Germany (DE) King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) / جامعة الملك سعود بن عبد العزيز للعلوم الصحية Saudi Arabia (SA) University of British Columbia Canada (CA) Leiden University Medical Center Netherlands (NL) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR)

How to cite

APA:

Gnanenthiran, S.R., Naoum, C., Leipsic, J.A., Achenbach, S., Al-Mallah, M.H., Andreini, D.,... Min, J.K. (2019). Long-term prognostic utility of computed tomography coronary angiography in older populations. European Heart Journal - Cardiovascular Imaging, 20(11), 1279-1286. https://doi.org/10.1093/ehjci/jez067

MLA:

Gnanenthiran, Sonali R., et al. "Long-term prognostic utility of computed tomography coronary angiography in older populations." European Heart Journal - Cardiovascular Imaging 20.11 (2019): 1279-1286.

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