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Improved 5-year prediction of all-cause mortality by coronary CT angiography applying the CONFIRM score

Authors
 Simon Deseive  ;  Leslee J. Shaw  ;  James K. Min  ;  Stephan Achenbach  ;  Daniele Andreini  ;  Mouaz H. Al-Mallah  ;  Daniel S. Berman  ;  Matthew J. Budoff  ;  Tracy Q. Callister  ;  Filippo Cademartiri  ;  Hyuk-Jae Chang  ;  Kavitha Chinnaiyan  ;  Benjamin J.W. Chow  ;  Ricardo C. Cury  ;  Augustin DeLago  ;  Allison M. Dunning  ;  Gudrun Feuchtner  ;  Philipp A. Kaufmann  ;  Yong-Jin Kim  ;  Jonathon Leipsic  ;  Hugo Marques  ;  Erica Maffei  ;  Gianluca Pontone  ;  Gilbert Raff  ;  Ronin Rubinshtein  ;  Todd C. Villines  ;  Jörg Hausleiter  ;  Martin Hadamitzky 
Citation
 European Heart Journal-Cardiovascular Imaging, Vol.18(3) : 286-293, 2017 
Journal Title
 European Heart Journal-Cardiovascular Imaging 
ISSN
 2047-2404 
Issue Date
2017
MeSH
Aged ; Analysis of Variance ; Cause of Death* ; Cohort Studies ; Computed Tomography Angiography/methods* ; Coronary Angiography/methods* ; Coronary Artery Disease/diagnostic imaging* ; Coronary Artery Disease/mortality* ; Coronary Artery Disease/physiopathology ; Disease-Free Survival ; Female ; Humans ; Internationality ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Proportional Hazards Models ; Quality Improvement ; ROC Curve ; Registries* ; Risk Assessment ; Severity of Illness Index ; Survival Analysis ; Time Factors
Keywords
Cardiac computer tomographic angiography ; Coronary Artery Disease ; Prognosis
Abstract
Aims: To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA). Methods and results: Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality. The predictive value of the CONFIRM score over clinical risk scores (Morise, Framingham, and NCEP ATP III score) was studied in the entire patient population as well as in subgroups. Improvement in risk prediction and patient reclassification were assessed using categorical net reclassification index (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 5.3 years, 982 (6.5%) of 15 219 patients died. The CONFIRM score outperformed the prognostic value of the studied three clinical risk scores (c-indices: CONFIRM score 0.696, NCEP ATP III score 0.675, Framingham score 0.610, Morise score 0.606; c-index for improvement CONFIRM score vs. NCEP ATP III score 0.650, P < 0.0001). Application of the CONFIRM score allowed reclassification of 34% of patients when compared with the NCEP ATP III score, which was the best clinical risk score. Reclassification was significant as revealed by categorical NRI (0.06 with 95% CI 0.02 and 0.10, P = 0.005) and IDI (0.013 with 95% CI 0.01 and 0.015, P < 0.001). Subgroup analysis revealed a comparable performance in a variety of patient subgroups. Conclusions: The CONFIRM score permits a significantly improved prediction of mortality over clinical risk scores for >5 years after CCTA. These findings are consistent in a large variety of patient subgroups.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/160866
DOI
10.1093/ehjci/jew195
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
장혁재(Chang, Hyuck Jae)
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