Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Donghee Han, New York Presbyterian Hospital
Bríain Hartaigh, New York Presbyterian Hospital
Heidi Gransar, Cedars-Sinai Medical Center
Ji Hyun Lee, New York Presbyterian Hospital
Asim Rizvi, New York Presbyterian Hospital
Lohendran Baskaran, New York Presbyterian Hospital
Joshua Schulman-Marcus, Albany Medical Center
Allison Dunning, Duke Clinical Research Institute
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Mouaz H. Al-Mallah, King Saud bin Abdulaziz University for Health Sciences
Daniel S. Berman, Cedars-Sinai Medical Center
Matthew J. Budoff, Harbor-UCLA Medical Center
Filippo Cademartiri, IRCCS Fondazione SDN
Erica Maffei, Erasmus MC
Tracy Q. Callister, Ospedale di Urbino
Kavitha Chinnaiyan, Tennessee Heart and Vascular Institute
Benjamin J.W. Chow, William Beaumont Hospital
Augustin Delago, University of Ottawa, Canada
Martin Hadamitzky, Capitol Cardiology Associates
Joerg Hausleiter, Deutsches Herzzentrum München
Philipp A. Kaufmann, Ludwig-Maximilians-Universität München
Gilbert Raff, Tennessee Heart and Vascular Institute
Leslee J. Shaw, UniversitatsSpital Zurich
Todd C. Villines, Emory University School of Medicine
Yong Jin Kim, Walter Reed National Military Medical Center
Jonathon Leipsic, Seoul National University Hospital
Gudrun Feuchtner, The University of British Columbia
Ricardo C. Cury, Medizinische Universitat Innsbruck
Gianluca Pontone, Baptist Cardiac and Vascular Institute
Daniele Andreini, Baptist Cardiac and Vascular Institute
Hugo Marques, IRCCS Centro Cardiologico Monzino
Ronen Rubinshtein, Hospital da Luz
Niree Hindoyan, New York Presbyterian Hospital


© The Author(s) 2017. Aims Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults. Methods and results Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles. Conclusion CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.