Incremental prognostic value of cardiac computed tomography in coronary artery disease using confirm coronary computed tomography angiography evaluation for clinical outcomes: An international multicenter registry

Benjamin J.W. Chow, Gary Small, Yeung Yam, Li Chen, Stephan Achenbach, Mouaz Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Victor Cheng, Kavitha M. Chinnaiyan, Augustin Delago, Allison Dunning, Martin Hadamitzky, Jörg Hausleiter, Philipp Kaufmann, Fay Lin, Erica MaffeiGilbert L. Raff, Leslee J. Shaw, Todd C. Villines, James K. Min

Research output: Contribution to journalArticle

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Abstract

Background-Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables. Methods and Results-A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non-high-risk, or high-risk CAD) and LVEF <50%. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3%) patients (mean follow-up of 22.5 months; 95% confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65% of patients without coronary atherosclerosis, 1.99% of patients with nonobstructive CAD, 2.90% of patients with non-high-risk CAD, and 4.95% for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50%% (hazard ratio, 2.74; 95% confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95% confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables. Conclusions-Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.

Original languageEnglish
Pages (from-to)463-472
Number of pages10
JournalCirculation: Cardiovascular Imaging
Volume4
Issue number5
DOIs
Publication statusPublished - 2011 Sep 1

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Registries
Coronary Artery Disease
Tomography
Stroke Volume
Angiography
Confidence Intervals
Mortality
Computed Tomography Angiography
Heart Transplantation
Multicenter Studies
Cause of Death
Myocardial Infarction
Cholesterol
Education

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Chow, Benjamin J.W. ; Small, Gary ; Yam, Yeung ; Chen, Li ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Berman, Daniel S. ; Budoff, Matthew J. ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Cheng, Victor ; Chinnaiyan, Kavitha M. ; Delago, Augustin ; Dunning, Allison ; Hadamitzky, Martin ; Hausleiter, Jörg ; Kaufmann, Philipp ; Lin, Fay ; Maffei, Erica ; Raff, Gilbert L. ; Shaw, Leslee J. ; Villines, Todd C. ; Min, James K. / Incremental prognostic value of cardiac computed tomography in coronary artery disease using confirm coronary computed tomography angiography evaluation for clinical outcomes : An international multicenter registry. In: Circulation: Cardiovascular Imaging. 2011 ; Vol. 4, No. 5. pp. 463-472.
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title = "Incremental prognostic value of cardiac computed tomography in coronary artery disease using confirm coronary computed tomography angiography evaluation for clinical outcomes: An international multicenter registry",
abstract = "Background-Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables. Methods and Results-A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non-high-risk, or high-risk CAD) and LVEF <50{\%}. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3{\%}) patients (mean follow-up of 22.5 months; 95{\%} confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65{\%} of patients without coronary atherosclerosis, 1.99{\%} of patients with nonobstructive CAD, 2.90{\%} of patients with non-high-risk CAD, and 4.95{\%} for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50{\%}{\%} (hazard ratio, 2.74; 95{\%} confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95{\%} confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables. Conclusions-Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.",
author = "Chow, {Benjamin J.W.} and Gary Small and Yeung Yam and Li Chen and Stephan Achenbach and Mouaz Al-Mallah and Berman, {Daniel S.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Victor Cheng and Chinnaiyan, {Kavitha M.} and Augustin Delago and Allison Dunning and Martin Hadamitzky and J{\"o}rg Hausleiter and Philipp Kaufmann and Fay Lin and Erica Maffei and Raff, {Gilbert L.} and Shaw, {Leslee J.} and Villines, {Todd C.} and Min, {James K.}",
year = "2011",
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doi = "10.1161/CIRCIMAGING.111.964155",
language = "English",
volume = "4",
pages = "463--472",
journal = "Circulation: Cardiovascular Imaging",
issn = "1941-9651",
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Chow, BJW, Small, G, Yam, Y, Chen, L, Achenbach, S, Al-Mallah, M, Berman, DS, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Cheng, V, Chinnaiyan, KM, Delago, A, Dunning, A, Hadamitzky, M, Hausleiter, J, Kaufmann, P, Lin, F, Maffei, E, Raff, GL, Shaw, LJ, Villines, TC & Min, JK 2011, 'Incremental prognostic value of cardiac computed tomography in coronary artery disease using confirm coronary computed tomography angiography evaluation for clinical outcomes: An international multicenter registry', Circulation: Cardiovascular Imaging, vol. 4, no. 5, pp. 463-472. https://doi.org/10.1161/CIRCIMAGING.111.964155

Incremental prognostic value of cardiac computed tomography in coronary artery disease using confirm coronary computed tomography angiography evaluation for clinical outcomes : An international multicenter registry. / Chow, Benjamin J.W.; Small, Gary; Yam, Yeung; Chen, Li; Achenbach, Stephan; Al-Mallah, Mouaz; Berman, Daniel S.; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Cheng, Victor; Chinnaiyan, Kavitha M.; Delago, Augustin; Dunning, Allison; Hadamitzky, Martin; Hausleiter, Jörg; Kaufmann, Philipp; Lin, Fay; Maffei, Erica; Raff, Gilbert L.; Shaw, Leslee J.; Villines, Todd C.; Min, James K.

In: Circulation: Cardiovascular Imaging, Vol. 4, No. 5, 01.09.2011, p. 463-472.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incremental prognostic value of cardiac computed tomography in coronary artery disease using confirm coronary computed tomography angiography evaluation for clinical outcomes

T2 - An international multicenter registry

AU - Chow, Benjamin J.W.

AU - Small, Gary

AU - Yam, Yeung

AU - Chen, Li

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Cheng, Victor

AU - Chinnaiyan, Kavitha M.

AU - Delago, Augustin

AU - Dunning, Allison

AU - Hadamitzky, Martin

AU - Hausleiter, Jörg

AU - Kaufmann, Philipp

AU - Lin, Fay

AU - Maffei, Erica

AU - Raff, Gilbert L.

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Min, James K.

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Background-Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables. Methods and Results-A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non-high-risk, or high-risk CAD) and LVEF <50%. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3%) patients (mean follow-up of 22.5 months; 95% confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65% of patients without coronary atherosclerosis, 1.99% of patients with nonobstructive CAD, 2.90% of patients with non-high-risk CAD, and 4.95% for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50%% (hazard ratio, 2.74; 95% confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95% confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables. Conclusions-Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.

AB - Background-Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables. Methods and Results-A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non-high-risk, or high-risk CAD) and LVEF <50%. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3%) patients (mean follow-up of 22.5 months; 95% confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65% of patients without coronary atherosclerosis, 1.99% of patients with nonobstructive CAD, 2.90% of patients with non-high-risk CAD, and 4.95% for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50%% (hazard ratio, 2.74; 95% confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95% confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables. Conclusions-Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.

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