Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry

Chaitu Cheruvua; Bruce Preciousa; Christopher Naouma; Philipp Blankea; Amir Ahmadib; Jeanette Soona; Chesnaldey Arepallia; Heidi Gransarc; Stephan Achenbachd; Daniel S. Bermane; Matthew J. Budofff; Tracy Q. Callisterg; Mouaz H. Al-Mallahh; Filippo Cademartirii; Kavitha Chinnaiyanj; Ronen Rubinshteink; Hugo Marquezl; Augustin DeLagom; Todd C. Villinesn; Martin Hadamitzkyo; Joerg Hausleiterp; Leslee J. Shawq; Philipp A. Kaufmannr; Ricardo C. Curys; Gudrun Feuchtnert; Yong-Jin Kimu; Erica Maffeii; Gilbert Raffj; Gianluca Pontonev; Daniele Andreiniv; Hyuk-Jae Changw; James K. Minx; Jonathon Leipsic

doi:10.1016/j.jcct.2015.12.005

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Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry

Authors: Chaitu Cheruvua ; Bruce Preciousa ; Christopher Naouma ; Philipp Blankea ; Amir Ahmadib ; Jeanette Soona ; Chesnaldey Arepallia ; Heidi Gransarc ; Stephan Achenbachd ; Daniel S. Bermane ; Matthew J. Budofff ; Tracy Q. Callisterg ; Mouaz H. Al-Mallahh ; Filippo Cademartirii ; Kavitha Chinnaiyanj ; Ronen Rubinshteink ; Hugo Marquezl ; Augustin DeLagom ; Todd C. Villinesn ; Martin Hadamitzkyo ; Joerg Hausleiterp ; Leslee J. Shawq ; Philipp A. Kaufmannr ; Ricardo C. Curys ; Gudrun Feuchtnert ; Yong-Jin Kimu ; Erica Maffeii ; Gilbert Raffj ; Gianluca Pontonev ; Daniele Andreiniv ; Hyuk-Jae Changw ; James K. Minx ; Jonathon Leipsic

Citation: JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, Vol.10(1) : 22-27, 2016

Journal Title: JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY

ISSN: 1934-5925

Issue Date: 2016

MeSH: Coronary Angiography/statistics & numerical data* ; Coronary Artery Disease/diagnostic imaging* ; Coronary Artery Disease/mortality* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Internationality ; Longitudinal Studies ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models* ; Registries* ; Reproducibility of Results ; Risk Assessment/methods* ; Sensitivity and Specificity ; Survival Analysis ; Tomography, X-Ray Computed

Keywords: All-cause mortality ; Coronary artery disease ; Coronary computed tomographic angiography ; Major adverse cardiovascular events

Abstract: BACKGROUND: Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE).
OBJECTIVE: Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE.
METHODS: From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days).
RESULTS: Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend.
CONCLUSIONS: In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period.