Improved 5-year prediction of all-cause mortality by coronary CT angiography applying the CONFIRM score

Simon Deseive, Leslee J. Shaw, James K. Min, Stephan Achenbach, Daniele Andreini, Mouaz H. Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Tracy Q. Callister, Filippo Cademartiri, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin DeLago, Allison M. Dunning, Gudrun Feuchtner, Philipp A. Kaufmann, Yong Jin Kim, Jonathon LeipsicHugo Marques, Erica Maffei, Gianluca Pontone, Gilbert Raff, Ronin Rubinshtein, Todd C. Villines, Jörg Hausleiter, Martin Hadamitzky

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Abstract

Aims To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA). Methods and results Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality. The predictive value of the CONFIRM score over clinical risk scores (Morise, Framingham, and NCEP ATP III score) was studied in the entire patient population as well as in subgroups. Improvement in risk prediction and patient reclassification were assessed using categorical net reclassification index (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 5.3 years, 982 (6.5%) of 15 219 patients died. The CONFIRM score outperformed the prognostic value of the studied three clinical risk scores (c-indices: CONFIRM score 0.696, NCEP ATP III score 0.675, Framingham score 0.661, Morise score 0.606; c-index for improvement CONFIRM score vs. NCEP ATP III score 0.650, P < 0.0001). Application of the CONFIRM score allowed reclassification of 34% of patients when compared with the NCEP ATP III score, which was the best clinical risk score. Reclassification was significant as revealed by categorical NRI (0.06 with 95% CI 0.02 and 0.10, P = 0.005) and IDI (0.013 with 95% CI 0.01 and 0.015, P < 0.001). Subgroup analysis revealed a comparable performance in a variety of patient subgroups. Conclusions The CONFIRM score permits a significantly improved prediction of mortality over clinical risk scores for >5 years after CCTA. These findings are consistent in a large variety of patient subgroups.

Original languageEnglish
Pages (from-to)286-293
Number of pages8
JournalEuropean heart journal cardiovascular Imaging
Volume18
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

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All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Deseive, S., Shaw, L. J., Min, J. K., Achenbach, S., Andreini, D., Al-Mallah, M. H., Berman, D. S., Budoff, M. J., Callister, T. Q., Cademartiri, F., Chang, H. J., Chinnaiyan, K., Chow, B. J. W., Cury, R. C., DeLago, A., Dunning, A. M., Feuchtner, G., Kaufmann, P. A., Kim, Y. J., ... Hadamitzky, M. (2017). Improved 5-year prediction of all-cause mortality by coronary CT angiography applying the CONFIRM score. European heart journal cardiovascular Imaging, 18(3), 286-293. https://doi.org/10.1093/ehjci/jew195