Long-term prognostic utility of computed tomography coronary angiography in older
European Heart Journal of Cardiovascular Imaging
Gnanenthiran SR1, Naoum C1, Leipsic JA2, Achenbach S3, Al-Mallah MH4, Andreini D5, Bax JJ6, Berman DS7, Budoff MJ8, Cademartiri F9, Callister TQ10, Chang HJ11, Chinnaiyan K12, Chow BJW13, Cury RC14, DeLago A15, Feuchtner G16, Hadamitzky M17, Hausleiter J18, Kaufman PA19, Kim YJ20, Maffei E21, Marques H22, de Araújo Gonçalves P22, Pontone G5, Raff GL12, Rubinshtein R23, Shaw LJ24, Villines TC25, Gransar H26, Lu Y27, Jones EC24, Peña JM24, Lin FY24, Kritharides L1, Min JK24.
1 Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
2 Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
3 Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Germany.
4 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.
5 Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy.
6 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
7 Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
8 Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA.
9 Cardiovascular Imaging Center, SDN IRCCS, Naples, 113, Italy.
10 Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
11 Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
12 Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
13 Department of Medicine and Radiology, University of Ottawa, ON, Canada.
14 Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA.
15 Capitol Cardiology Associates, Albany, NY, USA.
16 Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
17 Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
18 Medizinische Klinik I der Ludwig-Maximilians-UniversitätMönchen, Munich, Germany.
19 Department of Nuclear Medicine, University Hospital, Zurich, Switzerland and University of Zurich, 8091, Switzerland.
20 Seoul National University Hospital, Seoul, South Korea.
21 Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.
22 UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, 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.
24 Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
25 Cardiology Service, Walter Reed National Military Center, Bethesda, Maryland, United States of America.
26 Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.
27 Department of Healthcare Policy and Research, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
Year of Publication:
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.
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.