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Long-term prognostic utility of computed tomography coronary angiography in older populations

Authors
 Sonali R. Gnanenthiran  ;  Christopher Naoum  ;  Jonathon A. Leipsic  ;  Stephan Achenbach  ;  Mouaz H. Al-Mallah  ;  Daniele Andreini  ;  Jeroen J. Bax  ;  Daniel S. Berman  ;  Matthew J. Budoff  ;  Filippo Cademartiri  ;  Tracy Q. Callister  ;  Hyuk-Jae Chang  ;  Kavitha Chinnaiyan  ;  Benjamin J.W. Chow  ;  Ricardo C. Cury  ;  Augustin DeLago  ;  Gudrun Feuchtner  ;  Martin Hadamitzky  ;  Joerg Hausleiter  ;  Philipp A. Kaufman  ;  Yong-Jin Kim  ;  Erica Maffei  ;  Hugo Marques  ;  Pedro de Arau´ jo Gonc¸alves  ;  Gianluca Pontone  ;  Gilbert L. Raff  ;  Ronen Rubinshtein  ;  Leslee J. Shaw  ;  Todd C. Villines  ;  Heidi Gransar  ;  Yao Lu  ;  Erica C. Jones  ;  Jessica M. Pe~na  ;  Fay Y. Lin  ;  Leonard Kritharides  ;  James K. Min 
Citation
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol.20(11) : 1279-1286, 2019 
Journal Title
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING 
ISSN
 2047-2404 
Issue Date
2019
Keywords
age ; coronary computed tomography angiography ; major adverse cardiovascular events ; mortality ; older populations
Abstract
AIMS: The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations. METHODS AND RESULTS: From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: none, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD. CONCLUSION: The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.
Full Text
https://academic.oup.com/ehjcimaging/article/20/11/1279/5472788
DOI
10.1093/ehjci/jez067
Appears in Collections:
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
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174609
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