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Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM])

 Donghee Han  ;  Ashley Beecy  ;  Khalil Anchouche  ;  Heidi Gransar  ;  Patricia C. Dunham  ;  Ji-Hyun Lee  ;  Stephan Achenbach  ;  Mouaz H. Al-Mallah  ;  Daniele Andreini  ;  Daniel S. Berman  ;  Jeroen J. Bax  ;  Matthew J. Budoff  ;  Filippo Cademartiri  ;  Tracy Q. Callister  ;  Hyuk-Jae Chang  ;  Kavitha Chinnaiyan  ;  Bnjamin J.W. Chow  ;  Ricardo C. Cury  ;  Augustin DeLago  ;  Gudrun Feuchtner  ;  Martin Hadamitzky  ;  Joerg Hausleiter  ;  Philipp A. Kaufmann  ;  Yong-Jin Kim  ;  Jonathon A. Leipsic  ;  Erica Maffei  ;  Hugo Marques  ;  Pedro de Araújo Gonçalves  ;  Gianluca Pontone  ;  Gilbert L. Raff  ;  Ronen Rubinshtein  ;  Todd C. Villines  ;  Yao Lu MSc  ;  Jessica M. Peña  ;  Leslee J. Shaw  ;  James K. Min  ;  Fay Y. Lin 
 AMERICAN JOURNAL OF CARDIOLOGY, Vol.124(9) : 1397-1405, 2019 
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The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p >0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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