Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age

Chadi Ayoub, University of Ottawa Heart Institute
Leonard Kritharides, The University of Sydney
Yeung Yam, University of Ottawa Heart Institute
Li Chen, University of Ottawa Heart Institute
Alomgir Hossain, University of Ottawa Heart Institute
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Mouaz H. Al-Mallah, King Abdullah International Medical Research Center
Daniele Andreini, Università degli Studi di Milano
Daniel S. Berman, Cedars-Sinai Medical Center
Matthew J. Budoff, Harbor-UCLA Medical Center
Filippo Cademartiri, Giovanni XXIII Hospital
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Hyuk Jae Chang, Yonsei University College of Medicine
Kavitha Chinnaiyan, William Beaumont Hospital
Ricardo C. Cury, Baptist Cardiac and Vascular Institute
Augustin Delago, Capitol Cardiology Associates
Allison Dunning, Duke Clinical Research Institute
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Millie Gomez, New York Presbyterian Hospital
Heidi Gransar, Cedars-Sinai Medical Center
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Deutsches Herzzentrum München
Niree Hindoyan, New York Presbyterian Hospital
Philipp A. Kaufmann, UniversitatsSpital Zurich
Yong Jin Kim, Seoul National University Hospital
Jonathon Leipsic, The University of British Columbia
Erica Maffei, Giovanni XXIII Hospital
Hugo Marques, Hospital Curry Cabral
Gianluca Pontone, Università degli Studi di Milano
Gilbert Raff, William Beaumont Hospital
Ronen Rubinshtein, Technion - Israel Institute of Technology
Leslee J. Shaw, Emory University School of Medicine
Todd C. Villines, Walter Reed National Military Medical Center


© 2018 Springer Japan KK, part of Springer Nature Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of ‘age adjusted SIS’ (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7 years, 55.8% male) with a median follow-up of 27.3 months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83–3.16, p < 0.001), C-statistic 0.723 (0.700–0.756), net reclassification improvement (NRI) 0.36 (0.26–0.47, p < 0.001), and relative integrated discrimination improvement (IDI) 0.33 (p = 0.009). aSIS had HR 3.48 (2.33–5.18, p < 0.001) for mortality in those without obstructive CAD, compared to HR 1.79 (1.25–2.58, p = 0.02) in those with obstructive CAD. In conclusion, aSIS has an incremental prognostic value to traditional risk factors and obstructive CAD, and may enhance CCTA risk stratification.