Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Donghee Han; Bríain Hartaigh; Heidi Gransar; Ji Hyun Lee; Asim Rizvi; Lohendran Baskaran; Joshua Schulman-Marcus; Allison Dunning; Stephan Achenbach; Mouaz H. Al-Mallah; Daniel S. Berman; Matthew J. Budoff; Filippo Cademartiri; Erica Maffei; Tracy Q. Callister; Kavitha Chinnaiyan; Benjamin J.W. Chow; Augustin Delago; Martin Hadamitzky; Joerg Hausleiter; Philipp A. Kaufmann; Gilbert Raff; Leslee J. Shaw; Todd C. Villines; Yong Jin Kim; Jonathon Leipsic; Gudrun Feuchtner; Ricardo C. Cury; Gianluca Pontone; Daniele Andreini; Hugo Marques; Ronen Rubinshtein; Niree Hindoyan; Erica C. Jones; Millie Gomez; Fay Y. Lin; Hyuk Jae Chang; James K. Min

doi:10.1093/ehjci/jex150

Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Donghee Han, Bríain Hartaigh, Heidi Gransar, Ji Hyun Lee, Asim Rizvi, Lohendran Baskaran, Joshua Schulman-Marcus, Allison Dunning, Stephan Achenbach, Mouaz H. Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Erica Maffei, Tracy Q. Callister, Kavitha Chinnaiyan, Benjamin J.W. Chow, Augustin Delago, Martin Hadamitzky, Joerg HausleiterPhilipp A. Kaufmann, Gilbert Raff, Leslee J. Shaw, Todd C. Villines, Yong Jin Kim, Jonathon Leipsic, Gudrun Feuchtner, Ricardo C. Cury, Gianluca Pontone, Daniele Andreini, Hugo Marques, Ronen Rubinshtein, Niree Hindoyan, Erica C. Jones, Millie Gomez, Fay Y. Lin, Hyuk Jae Chang, James K. Min

Department of Internal Medicine

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

26 Citations (Scopus)

Abstract

Aims Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults. Methods and results Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles. Conclusion CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.

Original language	English
Pages (from-to)	675-683
Number of pages	9
Journal	European heart journal cardiovascular Imaging
Volume	19
Issue number	6
DOIs	https://doi.org/10.1093/ehjci/jex150
Publication status	Published - 2018 Jun 1

Bibliographical note

Funding Information:
The research reported in this publication was funded by the Heart Lung and Blood Institute of the National Institutes of Health (Bethesda, MD, USA) under award number R01HL115150, and also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA).

Funding Information:
Conflicts of interest: Dr. James Min serves on the scientific advisory board of Arineta, has ownership in MDDX, and has a research agreement with GE Healthcare. Dr Gianluca Pontone is a member of the speakers’ bureau for GE Healthcare, Bracco, and Medtronic. He also conducts research for GE Healthcare and Heartflow. Dr Matthew Budoff receives grant support from GE Healthcare and the NIH. All other authors have no relevant disclosures.

Publisher Copyright:
© The Author(s) 2017.

All Science Journal Classification (ASJC) codes

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

Access to Document

10.1093/ehjci/jex150

Cite this

Han, D., Hartaigh, B., Gransar, H., Lee, J. H., Rizvi, A., Baskaran, L., Schulman-Marcus, J., Dunning, A., Achenbach, S., Al-Mallah, M. H., Berman, D. S., Budoff, M. J., Cademartiri, F., Maffei, E., Callister, T. Q., Chinnaiyan, K., Chow, B. J. W., Delago, A., Hadamitzky, M., ... Min, J. K. (2018). Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. European heart journal cardiovascular Imaging, 19(6), 675-683. https://doi.org/10.1093/ehjci/jex150

@article{9994e2f9d4e14ee3a5da35176b845e93,

title = "Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals",

abstract = "Aims Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults. Methods and results Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles. Conclusion CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.",

author = "Donghee Han and Br{\'i}ain Hartaigh and Heidi Gransar and Lee, {Ji Hyun} and Asim Rizvi and Lohendran Baskaran and Joshua Schulman-Marcus and Allison Dunning and Stephan Achenbach and Al-Mallah, {Mouaz H.} and Berman, {Daniel S.} and Budoff, {Matthew J.} and Filippo Cademartiri and Erica Maffei and Callister, {Tracy Q.} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Augustin Delago and Martin Hadamitzky and Joerg Hausleiter and Kaufmann, {Philipp A.} and Gilbert Raff and Shaw, {Leslee J.} and Villines, {Todd C.} and Kim, {Yong Jin} and Jonathon Leipsic and Gudrun Feuchtner and Cury, {Ricardo C.} and Gianluca Pontone and Daniele Andreini and Hugo Marques and Ronen Rubinshtein and Niree Hindoyan and Jones, {Erica C.} and Millie Gomez and Lin, {Fay Y.} and Chang, {Hyuk Jae} and Min, {James K.}",

note = "Funding Information: The research reported in this publication was funded by the Heart Lung and Blood Institute of the National Institutes of Health (Bethesda, MD, USA) under award number R01HL115150, and also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA). Funding Information: Conflicts of interest: Dr. James Min serves on the scientific advisory board of Arineta, has ownership in MDDX, and has a research agreement with GE Healthcare. Dr Gianluca Pontone is a member of the speakers{\textquoteright} bureau for GE Healthcare, Bracco, and Medtronic. He also conducts research for GE Healthcare and Heartflow. Dr Matthew Budoff receives grant support from GE Healthcare and the NIH. All other authors have no relevant disclosures. Publisher Copyright: {\textcopyright} The Author(s) 2017.",

year = "2018",

month = jun,

day = "1",

doi = "10.1093/ehjci/jex150",

language = "English",

volume = "19",

pages = "675--683",

journal = "European Heart Journal Cardiovascular Imaging",

issn = "2047-2404",

publisher = "Oxford University Press",

number = "6",

}

Han, D, Hartaigh, B, Gransar, H, Lee, JH, Rizvi, A, Baskaran, L, Schulman-Marcus, J, Dunning, A, Achenbach, S, Al-Mallah, MH, Berman, DS, Budoff, MJ, Cademartiri, F, Maffei, E, Callister, TQ, Chinnaiyan, K, Chow, BJW, Delago, A, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Raff, G, Shaw, LJ, Villines, TC, Kim, YJ, Leipsic, J, Feuchtner, G, Cury, RC, Pontone, G, Andreini, D, Marques, H, Rubinshtein, R, Hindoyan, N, Jones, EC, Gomez, M, Lin, FY, Chang, HJ & Min, JK 2018, 'Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals', European heart journal cardiovascular Imaging, vol. 19, no. 6, pp. 675-683. https://doi.org/10.1093/ehjci/jex150

Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. / Han, Donghee; Hartaigh, Bríain; Gransar, Heidi et al.

In: European heart journal cardiovascular Imaging, Vol. 19, No. 6, 01.06.2018, p. 675-683.

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

TY - JOUR

T1 - Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

AU - Han, Donghee

AU - Hartaigh, Bríain

AU - Gransar, Heidi

AU - Lee, Ji Hyun

AU - Rizvi, Asim

AU - Baskaran, Lohendran

AU - Schulman-Marcus, Joshua

AU - Dunning, Allison

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz H.

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Maffei, Erica

AU - Callister, Tracy Q.

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Delago, Augustin

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufmann, Philipp A.

AU - Raff, Gilbert

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Feuchtner, Gudrun

AU - Cury, Ricardo C.

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Marques, Hugo

AU - Rubinshtein, Ronen

AU - Hindoyan, Niree

AU - Jones, Erica C.

AU - Gomez, Millie

AU - Lin, Fay Y.

AU - Chang, Hyuk Jae

AU - Min, James K.

N1 - Funding Information: The research reported in this publication was funded by the Heart Lung and Blood Institute of the National Institutes of Health (Bethesda, MD, USA) under award number R01HL115150, and also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA). Funding Information: Conflicts of interest: Dr. James Min serves on the scientific advisory board of Arineta, has ownership in MDDX, and has a research agreement with GE Healthcare. Dr Gianluca Pontone is a member of the speakers’ bureau for GE Healthcare, Bracco, and Medtronic. He also conducts research for GE Healthcare and Heartflow. Dr Matthew Budoff receives grant support from GE Healthcare and the NIH. All other authors have no relevant disclosures. Publisher Copyright: © The Author(s) 2017.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Aims Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults. Methods and results Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles. Conclusion CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.

AB - Aims Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults. Methods and results Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles. Conclusion CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.

UR - http://www.scopus.com/inward/record.url?scp=85048165090&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048165090&partnerID=8YFLogxK

U2 - 10.1093/ehjci/jex150

DO - 10.1093/ehjci/jex150

M3 - Article

C2 - 28977374

AN - SCOPUS:85048165090

SN - 2047-2404

VL - 19

SP - 675

EP - 683

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 6

ER -

Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

Access to Document

Other files and links

Fingerprint

Cite this