Title

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

Document Type

Article

Publication Date

6-1-2018

Publication Title

Eur Heart J Cardiovasc Imaging

ISSN

2047-2412

Abstract

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

Volume

19

Issue

6

First Page

675

Last Page

683

PubMed ID

28977374

DOI

10.1093/ehjci/jex150

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