Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study

Iksung Cho, Hyuk Jae Chang, Briain O. Hartaigh, Sanghoon Shin, Ji Min Sung, Fay Y. Lin, Stephan Achenbach, Ran Heo, Daniel S. Berman, Matthew J. Budoff, Tracy Q. Callister, Mouaz H. Al-Mallah, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J.W. Chow, Allison M. Dunning, Augustin DeLago, Todd C. Villines, Martin Hadamitzky, Joerg HausleiterJonathon Leipsic, Leslee J. Shaw, Philipp A. Kaufmann, Ricardo C. Cury, Gudrun Feuchtner, Yong Jin Kim, Erica Maffei, Gilbert Raff, Gianluca Pontone, Daniele Andreini, James K. Min

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Abstract

Aim Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. Methods and results From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels - as defined by the per-patient presence of a ≥50% luminal stenosis - was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ2, C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ2, 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS. Conclusion Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.

Original languageEnglish
Pages (from-to)501-508
Number of pages8
JournalEuropean heart journal
Volume36
Issue number8
DOIs
Publication statusPublished - 2015 Feb 21

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Coronary Angiography
Multicenter Studies
Coronary Vessels
Calcium
Coronary Artery Disease
Myocardial Infarction
Computed Tomography Angiography
Mortality
Registries
Pathologic Constriction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Cho, Iksung ; Chang, Hyuk Jae ; Hartaigh, Briain O. ; Shin, Sanghoon ; Sung, Ji Min ; Lin, Fay Y. ; Achenbach, Stephan ; Heo, Ran ; Berman, Daniel S. ; Budoff, Matthew J. ; Callister, Tracy Q. ; Al-Mallah, Mouaz H. ; Cademartiri, Filippo ; Chinnaiyan, Kavitha ; Chow, Benjamin J.W. ; Dunning, Allison M. ; DeLago, Augustin ; Villines, Todd C. ; Hadamitzky, Martin ; Hausleiter, Joerg ; Leipsic, Jonathon ; Shaw, Leslee J. ; Kaufmann, Philipp A. ; Cury, Ricardo C. ; Feuchtner, Gudrun ; Kim, Yong Jin ; Maffei, Erica ; Raff, Gilbert ; Pontone, Gianluca ; Andreini, Daniele ; Min, James K. / Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium : Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study. In: European heart journal. 2015 ; Vol. 36, No. 8. pp. 501-508.
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title = "Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study",
abstract = "Aim Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. Methods and results From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels - as defined by the per-patient presence of a ≥50{\%} luminal stenosis - was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ2, C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ2, 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS. Conclusion Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.",
author = "Iksung Cho and Chang, {Hyuk Jae} and Hartaigh, {Briain O.} and Sanghoon Shin and Sung, {Ji Min} and Lin, {Fay Y.} and Stephan Achenbach and Ran Heo and Berman, {Daniel S.} and Budoff, {Matthew J.} and Callister, {Tracy Q.} and Al-Mallah, {Mouaz H.} and Filippo Cademartiri and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Dunning, {Allison M.} and Augustin DeLago and Villines, {Todd C.} and Martin Hadamitzky and Joerg Hausleiter and Jonathon Leipsic and Shaw, {Leslee J.} and Kaufmann, {Philipp A.} and Cury, {Ricardo C.} and Gudrun Feuchtner and Kim, {Yong Jin} and Erica Maffei and Gilbert Raff and Gianluca Pontone and Daniele Andreini and Min, {James K.}",
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language = "English",
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pages = "501--508",
journal = "European Heart Journal",
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Cho, I, Chang, HJ, Hartaigh, BO, Shin, S, Sung, JM, Lin, FY, Achenbach, S, Heo, R, Berman, DS, Budoff, MJ, Callister, TQ, Al-Mallah, MH, Cademartiri, F, Chinnaiyan, K, Chow, BJW, Dunning, AM, DeLago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Leipsic, J, Shaw, LJ, Kaufmann, PA, Cury, RC, Feuchtner, G, Kim, YJ, Maffei, E, Raff, G, Pontone, G, Andreini, D & Min, JK 2015, 'Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study', European heart journal, vol. 36, no. 8, pp. 501-508. https://doi.org/10.1093/eurheartj/ehu358

Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium : Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study. / Cho, Iksung; Chang, Hyuk Jae; Hartaigh, Briain O.; Shin, Sanghoon; Sung, Ji Min; Lin, Fay Y.; Achenbach, Stephan; Heo, Ran; Berman, Daniel S.; Budoff, Matthew J.; Callister, Tracy Q.; Al-Mallah, Mouaz H.; Cademartiri, Filippo; Chinnaiyan, Kavitha; Chow, Benjamin J.W.; Dunning, Allison M.; DeLago, Augustin; Villines, Todd C.; Hadamitzky, Martin; Hausleiter, Joerg; Leipsic, Jonathon; Shaw, Leslee J.; Kaufmann, Philipp A.; Cury, Ricardo C.; Feuchtner, Gudrun; Kim, Yong Jin; Maffei, Erica; Raff, Gilbert; Pontone, Gianluca; Andreini, Daniele; Min, James K.

In: European heart journal, Vol. 36, No. 8, 21.02.2015, p. 501-508.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium

T2 - Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study

AU - Cho, Iksung

AU - Chang, Hyuk Jae

AU - Hartaigh, Briain O.

AU - Shin, Sanghoon

AU - Sung, Ji Min

AU - Lin, Fay Y.

AU - Achenbach, Stephan

AU - Heo, Ran

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Callister, Tracy Q.

AU - Al-Mallah, Mouaz H.

AU - Cademartiri, Filippo

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Dunning, Allison M.

AU - DeLago, Augustin

AU - Villines, Todd C.

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Leipsic, Jonathon

AU - Shaw, Leslee J.

AU - Kaufmann, Philipp A.

AU - Cury, Ricardo C.

AU - Feuchtner, Gudrun

AU - Kim, Yong Jin

AU - Maffei, Erica

AU - Raff, Gilbert

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Min, James K.

PY - 2015/2/21

Y1 - 2015/2/21

N2 - Aim Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. Methods and results From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels - as defined by the per-patient presence of a ≥50% luminal stenosis - was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ2, C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ2, 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS. Conclusion Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.

AB - Aim Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. Methods and results From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels - as defined by the per-patient presence of a ≥50% luminal stenosis - was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ2, C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ2, 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS. Conclusion Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.

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U2 - 10.1093/eurheartj/ehu358

DO - 10.1093/eurheartj/ehu358

M3 - Article

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SP - 501

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JO - European Heart Journal

JF - European Heart Journal

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