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
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.