Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings: Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease

James K. Min; Allison Dunning; Fay Y. Lin; Stephan Achenbach; Mouaz Al-Mallah; Matthew J. Budoff; Filippo Cademartiri; Tracy Q. Callister; Hyuk Jae Chang; Victor Cheng; Kavitha Chinnaiyan; Benjamin J.W. Chow; Augustin Delago; Martin Hadamitzky; Joerg Hausleiter; Philipp Kaufmann; Erica Maffei; Gilbert Raff; Leslee J. Shaw; Todd Villines; Daniel S. Berman

doi:10.1016/j.jacc.2011.02.074

Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings: Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease

James K. Min, Allison Dunning, Fay Y. Lin, Stephan Achenbach, Mouaz Al-Mallah, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Victor Cheng, Kavitha Chinnaiyan, Benjamin J.W. Chow, Augustin Delago, Martin Hadamitzky, Joerg Hausleiter, Philipp Kaufmann, Erica Maffei, Gilbert Raff, Leslee J. Shaw, Todd VillinesDaniel S. Berman

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

489 Citations (Scopus)

Abstract

Objectives: We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Background: Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes. Methods: We evaluated a consecutive cohort of 24,775 patients undergoing ≥64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (<70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models. Results: At a 2.3 ± 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age <65 years versus ≥65 years, younger patients experienced higher hazards for death for 2-vessel (HR: 4.00; 95% CI: 2.16 to 7.40; p < 0.0001 vs. HR: 2.46; 95% CI: 1.51 to 4.02; p = 0.0003) and 3-vessel (HR: 6.19; 95% CI: 3.43 to 11.2; p < 0.0001 vs. HR: 3.10; 95% CI: 1.95 to 4.92; p < 0.0001) CAD. The relative hazard for 3-vessel CAD (HR: 4.21; 95% CI: 2.47 to 7.18; p < 0.0001 vs. HR: 3.27; 95% CI: 1.96 to 5.45; p < 0.0001) was higher for women as compared with men. Conclusions: Among individuals without known CAD, nonobstructive and obstructive CAD by CCTA are associated with higher rates of mortality, with risk profiles differing for age and sex. Importantly, absence of CAD is associated with a very favorable prognosis.

Original language	English
Pages (from-to)	849-860
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	58
Issue number	8
DOIs	https://doi.org/10.1016/j.jacc.2011.02.074
Publication status	Published - 2011 Aug 16

Bibliographical note

Funding Information:
Dr. Min received modest speakers' bureau and medical advisory board compensation and significant research support from GE Healthcare. Dr. Achenbach received grant support from Siemens and Bayer Schering Pharma and has served as a consultant for Servier. Dr. Al-Mallah received support from the American Heart Association, BCBS Foundation of Michigan, and Astellas. Dr. Budoff received modest speakers' bureau compensation from GE Healthcare. Dr. Cademartiri received grant support from GE Healthcare . Dr. Callister has served on the Speakers' Bureau of General Electric Healthcare. Dr. Chinnaiyan received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI . Dr. Chow received research and fellowship support from GE Healthcare, research support from Pfizer and AstraZeneca, and educational support from TeraRecon. Dr. Hausleiter received a research grant from Siemens Medical Systems . Dr. Kaufmann received institutional research support from GE Healthcare and grant support from Swiss National Science Foundation . Dr. Maffei has served as a consultant to Servier and has received grant support from GE Healthcare . Dr. Raff received grant support from Siemens , Blue Cross Blue Shield Blue Care MI , and Bayer Pharma . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Cardiology and Cardiovascular Medicine

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Min, J. K., Dunning, A., Lin, F. Y., Achenbach, S., Al-Mallah, M., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Cheng, V., Chinnaiyan, K., Chow, B. J. W., Delago, A., Hadamitzky, M., Hausleiter, J., Kaufmann, P., Maffei, E., Raff, G., Shaw, L. J., ... Berman, D. S. (2011). Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings: Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. Journal of the American College of Cardiology, 58(8), 849-860. https://doi.org/10.1016/j.jacc.2011.02.074

Min, James K. ; Dunning, Allison ; Lin, Fay Y. ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Budoff, Matthew J. ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Cheng, Victor ; Chinnaiyan, Kavitha ; Chow, Benjamin J.W. ; Delago, Augustin ; Hadamitzky, Martin ; Hausleiter, Joerg ; Kaufmann, Philipp ; Maffei, Erica ; Raff, Gilbert ; Shaw, Leslee J. ; Villines, Todd ; Berman, Daniel S. / Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings : Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 8. pp. 849-860.

@article{c36bb92e74724cbd8f06ce9d2c15d764,

title = "Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings: Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease",

abstract = "Objectives: We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Background: Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes. Methods: We evaluated a consecutive cohort of 24,775 patients undergoing ≥64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (<70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models. Results: At a 2.3 ± 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age <65 years versus ≥65 years, younger patients experienced higher hazards for death for 2-vessel (HR: 4.00; 95% CI: 2.16 to 7.40; p < 0.0001 vs. HR: 2.46; 95% CI: 1.51 to 4.02; p = 0.0003) and 3-vessel (HR: 6.19; 95% CI: 3.43 to 11.2; p < 0.0001 vs. HR: 3.10; 95% CI: 1.95 to 4.92; p < 0.0001) CAD. The relative hazard for 3-vessel CAD (HR: 4.21; 95% CI: 2.47 to 7.18; p < 0.0001 vs. HR: 3.27; 95% CI: 1.96 to 5.45; p < 0.0001) was higher for women as compared with men. Conclusions: Among individuals without known CAD, nonobstructive and obstructive CAD by CCTA are associated with higher rates of mortality, with risk profiles differing for age and sex. Importantly, absence of CAD is associated with a very favorable prognosis.",

author = "Min, {James K.} and Allison Dunning and Lin, {Fay Y.} and Stephan Achenbach and Mouaz Al-Mallah and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Victor Cheng and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Augustin Delago and Martin Hadamitzky and Joerg Hausleiter and Philipp Kaufmann and Erica Maffei and Gilbert Raff and Shaw, {Leslee J.} and Todd Villines and Berman, {Daniel S.}",

note = "Funding Information: Dr. Min received modest speakers' bureau and medical advisory board compensation and significant research support from GE Healthcare. Dr. Achenbach received grant support from Siemens and Bayer Schering Pharma and has served as a consultant for Servier. Dr. Al-Mallah received support from the American Heart Association, BCBS Foundation of Michigan, and Astellas. Dr. Budoff received modest speakers' bureau compensation from GE Healthcare. Dr. Cademartiri received grant support from GE Healthcare . Dr. Callister has served on the Speakers' Bureau of General Electric Healthcare. Dr. Chinnaiyan received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI . Dr. Chow received research and fellowship support from GE Healthcare, research support from Pfizer and AstraZeneca, and educational support from TeraRecon. Dr. Hausleiter received a research grant from Siemens Medical Systems . Dr. Kaufmann received institutional research support from GE Healthcare and grant support from Swiss National Science Foundation . Dr. Maffei has served as a consultant to Servier and has received grant support from GE Healthcare . Dr. Raff received grant support from Siemens , Blue Cross Blue Shield Blue Care MI , and Bayer Pharma . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. ",

year = "2011",

month = aug,

day = "16",

doi = "10.1016/j.jacc.2011.02.074",

language = "English",

volume = "58",

pages = "849--860",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "8",

}

Min, JK, Dunning, A, Lin, FY, Achenbach, S, Al-Mallah, M, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Cheng, V, Chinnaiyan, K, Chow, BJW, Delago, A, Hadamitzky, M, Hausleiter, J, Kaufmann, P, Maffei, E, Raff, G, Shaw, LJ, Villines, T & Berman, DS 2011, 'Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings: Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease', Journal of the American College of Cardiology, vol. 58, no. 8, pp. 849-860. https://doi.org/10.1016/j.jacc.2011.02.074

Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings : Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. / Min, James K.; Dunning, Allison; Lin, Fay Y.; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Cheng, Victor; Chinnaiyan, Kavitha; Chow, Benjamin J.W.; Delago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J.; Villines, Todd; Berman, Daniel S.

In: Journal of the American College of Cardiology, Vol. 58, No. 8, 16.08.2011, p. 849-860.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings

T2 - Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease

AU - Min, James K.

AU - Dunning, Allison

AU - Lin, Fay Y.

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Cheng, Victor

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Delago, Augustin

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufmann, Philipp

AU - Maffei, Erica

AU - Raff, Gilbert

AU - Shaw, Leslee J.

AU - Villines, Todd

AU - Berman, Daniel S.

N1 - Funding Information: Dr. Min received modest speakers' bureau and medical advisory board compensation and significant research support from GE Healthcare. Dr. Achenbach received grant support from Siemens and Bayer Schering Pharma and has served as a consultant for Servier. Dr. Al-Mallah received support from the American Heart Association, BCBS Foundation of Michigan, and Astellas. Dr. Budoff received modest speakers' bureau compensation from GE Healthcare. Dr. Cademartiri received grant support from GE Healthcare . Dr. Callister has served on the Speakers' Bureau of General Electric Healthcare. Dr. Chinnaiyan received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI . Dr. Chow received research and fellowship support from GE Healthcare, research support from Pfizer and AstraZeneca, and educational support from TeraRecon. Dr. Hausleiter received a research grant from Siemens Medical Systems . Dr. Kaufmann received institutional research support from GE Healthcare and grant support from Swiss National Science Foundation . Dr. Maffei has served as a consultant to Servier and has received grant support from GE Healthcare . Dr. Raff received grant support from Siemens , Blue Cross Blue Shield Blue Care MI , and Bayer Pharma . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

PY - 2011/8/16

Y1 - 2011/8/16

N2 - Objectives: We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Background: Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes. Methods: We evaluated a consecutive cohort of 24,775 patients undergoing ≥64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (<70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models. Results: At a 2.3 ± 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age <65 years versus ≥65 years, younger patients experienced higher hazards for death for 2-vessel (HR: 4.00; 95% CI: 2.16 to 7.40; p < 0.0001 vs. HR: 2.46; 95% CI: 1.51 to 4.02; p = 0.0003) and 3-vessel (HR: 6.19; 95% CI: 3.43 to 11.2; p < 0.0001 vs. HR: 3.10; 95% CI: 1.95 to 4.92; p < 0.0001) CAD. The relative hazard for 3-vessel CAD (HR: 4.21; 95% CI: 2.47 to 7.18; p < 0.0001 vs. HR: 3.27; 95% CI: 1.96 to 5.45; p < 0.0001) was higher for women as compared with men. Conclusions: Among individuals without known CAD, nonobstructive and obstructive CAD by CCTA are associated with higher rates of mortality, with risk profiles differing for age and sex. Importantly, absence of CAD is associated with a very favorable prognosis.

AB - Objectives: We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Background: Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes. Methods: We evaluated a consecutive cohort of 24,775 patients undergoing ≥64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (<70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models. Results: At a 2.3 ± 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age <65 years versus ≥65 years, younger patients experienced higher hazards for death for 2-vessel (HR: 4.00; 95% CI: 2.16 to 7.40; p < 0.0001 vs. HR: 2.46; 95% CI: 1.51 to 4.02; p = 0.0003) and 3-vessel (HR: 6.19; 95% CI: 3.43 to 11.2; p < 0.0001 vs. HR: 3.10; 95% CI: 1.95 to 4.92; p < 0.0001) CAD. The relative hazard for 3-vessel CAD (HR: 4.21; 95% CI: 2.47 to 7.18; p < 0.0001 vs. HR: 3.27; 95% CI: 1.96 to 5.45; p < 0.0001) was higher for women as compared with men. Conclusions: Among individuals without known CAD, nonobstructive and obstructive CAD by CCTA are associated with higher rates of mortality, with risk profiles differing for age and sex. Importantly, absence of CAD is associated with a very favorable prognosis.

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Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings: Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. Journal of the American College of Cardiology. 2011 Aug 16;58(8):849-860. https://doi.org/10.1016/j.jacc.2011.02.074

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