Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals.
Eur Heart J Cardiovasc Imaging
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
Conclusion: CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.
Medical Subject Headings
Age Factors; Aged; Analysis of Variance; Asymptomatic Diseases; Cohort Studies; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Critical Illness; Female; Geriatric Assessment; Humans; Internationality; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Prognosis; Registries; Risk Assessment; Sex Factors; Survival Analysis; Vascular Calcification
Han D, Hartaigh BÓ, Gransar H, Lee JH, Rizvi A, Baskaran L, Schulman-Marcus J, Dunning A, Achenbach S, Al-Mallah MH, Berman DS, Budoff MJ, Cademartiri F, Maffei E, Callister TQ, Chinnaiyan K, Chow BJW, DeLago A, Hadamitzky M, Hausleiter J, Kaufmann PA, Raff G, Shaw LJ, Villines TC, Kim YJ, Leipsic J, Feuchtner G, Cury RC, Pontone G, Andreini D, Marques H, Rubinshtein R, Hindoyan N, Jones EC, Gomez M, Lin FY, Chang HJ, Min JK. Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. Eur Heart J Cardiovasc Imaging. 2018 Jun 1;19(6):675-683. doi: 10.1093/ehjci/jex150. PubMed PMID: 28977374; PubMed Central PMCID: PMC5963306.