Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: a 6-year follow-up from the prospective multicentre international CONFIRM study
Eur Heart J
Cho I1,2,3, Al’Aref SJ1, Berger A4, Ó Hartaigh B1, Gransar H5, Valenti V1, Lin FY1, Achenbach S5, Berman DS6, Budoff MJ7, Callister TQ8, Al-Mallah MH9, Cademartiri F10, Chinnaiyan K11, Chow BJW12, DeLago A13, Villines TC14, Hadamitzky M15, Hausleiter J16, Leipsic J17, Shaw LJ4, Kaufmann PA18, Feuchtner G19, Kim YJ20, Maffei E10, Raff G11, Pontone G21, Andreini D21, Marques H22, Rubinshtein R23, Chang HJ2, Min JK1.
1 Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, Weill Cornell Medical College, 413 East 69th Street, Suite 108, New York, NY 10021, USA.
2 Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
3 Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University, Seoul, South Korea.
4 Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
5 Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.
6 Department of Medicine, University of Erlangen, Erlangen, Germany.
7 Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.
8 Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
9 King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia.
10 Department of Radiology, Montreal Heart Institute, Montreal, Quebec, Canada.
11 William Beaumont Hospital, Royal Oaks, MI, USA.
12 Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada.
13 Capitol Cardiology Associates, Albany, NY, USA.
14 Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.
15 Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
16 Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
17 Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
18 University Hospital, Zurich, Switzerland.
19 Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
20 Seoul National University Hospital, Seoul, South Korea.
21 Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy.
22 UNICA, Cardiac CT and MRI Unit, Hospital da Luz, Lisbon, Portugal.
23 Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Year of Publication:
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).
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.