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Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events

Authors
 Christopher Naoum  ;  Daniel S. Berman  ;  Amir Ahmadi  ;  Philipp Blanke  ;  Heidi Gransar  ;  Jagat Narula  ;  Leslee J. Shaw  ;  Leonard Kritharides  ;  Stephan Achenbach  ;  Mouaz H. Al-Mallah  ;  Daniele Andreini  ;  Matthew J. Budoff  ;  Filippo Cademartiri  ;  Tracy Q. Callister  ;  Hyuk-Jae Chang  ;  Kavitha Chinnaiyan  ;  Benjamin Chow  ;  Ricardo C. Cury  ;  Augustin DeLago  ;  Allison Dunning  ;  Gudrun Feuchtner  ;  Martin Hadamitzky  ;  Joerg Hausleiter  ;  Philipp A. Kaufmann  ;  Yong-Jin Kim  ;  Erica Maffei  ;  Hugo Marquez  ;  Gianluca Pontone  ;  Gilbert Raff  ;  Ronen Rubinshtein  ;  Todd C. Villines  ;  James Min  ;  Jonathon Leipsic 
Citation
 Circulation. Cardiovascular Imaging, Vol.10(3) : e004896, 2017 
Journal Title
 Circulation. Cardiovascular Imaging 
ISSN
 1941-9651 
Issue Date
2017
MeSH
Adult ; Age Factors ; Aged ; Canada/epidemiology ; Computed Tomography Angiography* ; Coronary Angiography/methods* ; Coronary Artery Disease/diagnostic imaging* ; Coronary Artery Disease/epidemiology ; Coronary Vessels/diagnostic imaging* ; Europe/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography* ; Nomograms* ; Plaque, Atherosclerotic* ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Registries ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index ; Sex Factors ; United States/epidemiology
Keywords
computed tomography angiography ; coronary angiography ; coronary artery disease ; epidemiology ; nomograms
Abstract
BACKGROUND: Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. METHODS AND RESULTS: Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both). CONCLUSIONS: We have developed clinically pragmatic age- and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/160867
DOI
10.1161/CIRCIMAGING.116.004896
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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