Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry

Chaitu Cheruvu, Bruce Precious, Christopher Naoum, Philipp Blanke, Amir Ahmadi, Jeanette Soon, Chesnaldey Arepalli, Heidi Gransar, Stephan Achenbach, Daniel S. Berman, Matthew J. Budoff, Tracy Q. Callister, Mouaz H. Al-Mallah, Filippo Cademartiri, Kavitha Chinnaiyan, Ronen Rubinshtein, Hugo Marquez, Augustin DeLago, Todd C. Villines, Martin HadamitzkyJoerg Hausleiter, Leslee J. Shaw, Philipp A. Kaufmann, Ricardo C. Cury, Gudrun Feuchtner, Yong Jin Kim, Erica Maffei, Gilbert Raff, Gianluca Pontone, Daniele Andreini, Hyuk Jae Chang, James K. Min, Jonathon Leipsic

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE). Objective: Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE. Methods: From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days). Results: Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend. Conclusions: In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period.

Original languageEnglish
Pages (from-to)22-27
Number of pages6
JournalJournal of Cardiovascular Computed Tomography
Volume10
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Cheruvu, C., Precious, B., Naoum, C., Blanke, P., Ahmadi, A., Soon, J., Arepalli, C., Gransar, H., Achenbach, S., Berman, D. S., Budoff, M. J., Callister, T. Q., Al-Mallah, M. H., Cademartiri, F., Chinnaiyan, K., Rubinshtein, R., Marquez, H., DeLago, A., Villines, T. C., ... Leipsic, J. (2016). Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry. Journal of Cardiovascular Computed Tomography, 10(1), 22-27. https://doi.org/10.1016/j.jcct.2015.12.005