Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: A 6-year follow-up from the prospective multicentre international CONFIRM study


Iksung Cho, New York Presbyterian Hospital
Subhi J. Al'aref, New York Presbyterian Hospital
Adam Berger, Emory University School of Medicine
Bríain Ó Hartaigh, New York Presbyterian Hospital
Heidi Gransar, Cedars-Sinai Medical Center
Valentina Valenti, New York Presbyterian Hospital
Fay Y. Lin, New York Presbyterian Hospital
Stephan Achenbach, Cedars-Sinai Medical Center
Daniel S. Berman, Friedrich-Alexander-Universität Erlangen-Nürnberg
Matthew J. Budoff, Harbor-UCLA Medical Center
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Mouaz H. Al-Mallah, King Saud bin Abdulaziz University for Health Sciences
Filippo Cademartiri, Institut de Cardiologie de Montreal
Kavitha Chinnaiyan, William Beaumont Hospital
Benjamin J.W. Chow, University of Ottawa, Canada
Augustin Delago, Capitol Cardiology Associates
Todd C. Villines, Walter Reed National Military Medical Center
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Jonathon Leipsic, The University of British Columbia
Leslee J. Shaw, Emory University School of Medicine
Philipp A. Kaufmann, UniversitatsSpital Zurich
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Yong Jin Kim, Seoul National University Hospital
Erica Maffei, Institut de Cardiologie de Montreal
Gilbert Raff, William Beaumont Hospital
Gianluca Pontone, Università degli Studi di Milano
Daniele Andreini, Università degli Studi di Milano
Hugo Marques, Hospital da Luz
Ronen Rubinshtein, Technion - Israel Institute of Technology
Hyuk Jae Chang, Severance Hospital
James K. Min, New York Presbyterian Hospital

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European Heart Journal


© 2017 The Author. Aim 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 v2 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). Conclusions 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.





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