Optimized prognostic score for coronary computed tomographic angiography: Results from the CONFIRM registry (COronary CT angiography evaluation for clinical outcomes: An international multicenter registry)

Martin Hadamitzky, Stephan Achenbach, Mouaz Al-Mallah, Daniel Berman, Matthew Budoff, Filippo Cademartiri, Tracy Callister, Hyuk Jae Chang, Victor Cheng, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo Cury, Augustin Delago, Allison Dunning, Gudrun Feuchtner, Millie Gomez, Philipp Kaufmann, Yong Jin Kim, Jonathon Leipsic, Fay Y. LinErica Maffei, James K. Min, Gil Raff, Leslee J. Shaw, Todd C. Villines, Jörg Hausleiter

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104 Citations (Scopus)

Abstract

Objectives The aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with suspected coronary artery disease (CAD). Background Coronary computed tomography angiography carries important prognostic information in addition to the detection of obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk predictors. Methods The analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was modeled. The endpoint was all-cause mortality. Results During a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was the number of proximal segments with mixed or calcified plaques (C-index 0.64, p < 0.0001) and the number of proximal segments with a stenosis >50% (C-index 0.56, p = 0.002). In an optimized score including both parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or a stenosis >50% is equivalent to a 5-year increase in age or the risk of smoking. Conclusions In CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.

Original languageEnglish
Pages (from-to)468-476
Number of pages9
JournalJournal of the American College of Cardiology
Volume62
Issue number5
DOIs
Publication statusPublished - 2013 Jul 30

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Coronary Angiography
Registries
Angiography
Coronary Artery Disease
Pathologic Constriction
Cholesterol
Mortality
Computed Tomography Angiography
Smoking
Education
Survival
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Hadamitzky, Martin ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Berman, Daniel ; Budoff, Matthew ; Cademartiri, Filippo ; Callister, Tracy ; Chang, Hyuk Jae ; Cheng, Victor ; Chinnaiyan, Kavitha ; Chow, Benjamin J.W. ; Cury, Ricardo ; Delago, Augustin ; Dunning, Allison ; Feuchtner, Gudrun ; Gomez, Millie ; Kaufmann, Philipp ; Kim, Yong Jin ; Leipsic, Jonathon ; Lin, Fay Y. ; Maffei, Erica ; Min, James K. ; Raff, Gil ; Shaw, Leslee J. ; Villines, Todd C. ; Hausleiter, Jörg. / Optimized prognostic score for coronary computed tomographic angiography : Results from the CONFIRM registry (COronary CT angiography evaluation for clinical outcomes: An international multicenter registry). In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 5. pp. 468-476.
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title = "Optimized prognostic score for coronary computed tomographic angiography: Results from the CONFIRM registry (COronary CT angiography evaluation for clinical outcomes: An international multicenter registry)",
abstract = "Objectives The aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with suspected coronary artery disease (CAD). Background Coronary computed tomography angiography carries important prognostic information in addition to the detection of obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk predictors. Methods The analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was modeled. The endpoint was all-cause mortality. Results During a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was the number of proximal segments with mixed or calcified plaques (C-index 0.64, p < 0.0001) and the number of proximal segments with a stenosis >50{\%} (C-index 0.56, p = 0.002). In an optimized score including both parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or a stenosis >50{\%} is equivalent to a 5-year increase in age or the risk of smoking. Conclusions In CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.",
author = "Martin Hadamitzky and Stephan Achenbach and Mouaz Al-Mallah and Daniel Berman and Matthew Budoff and Filippo Cademartiri and Tracy Callister and Chang, {Hyuk Jae} and Victor Cheng and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Ricardo Cury and Augustin Delago and Allison Dunning and Gudrun Feuchtner and Millie Gomez and Philipp Kaufmann and Kim, {Yong Jin} and Jonathon Leipsic and Lin, {Fay Y.} and Erica Maffei and Min, {James K.} and Gil Raff and Shaw, {Leslee J.} and Villines, {Todd C.} and J{\"o}rg Hausleiter",
year = "2013",
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doi = "10.1016/j.jacc.2013.04.064",
language = "English",
volume = "62",
pages = "468--476",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
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Hadamitzky, M, Achenbach, S, Al-Mallah, M, Berman, D, Budoff, M, Cademartiri, F, Callister, T, Chang, HJ, Cheng, V, Chinnaiyan, K, Chow, BJW, Cury, R, Delago, A, Dunning, A, Feuchtner, G, Gomez, M, Kaufmann, P, Kim, YJ, Leipsic, J, Lin, FY, Maffei, E, Min, JK, Raff, G, Shaw, LJ, Villines, TC & Hausleiter, J 2013, 'Optimized prognostic score for coronary computed tomographic angiography: Results from the CONFIRM registry (COronary CT angiography evaluation for clinical outcomes: An international multicenter registry)', Journal of the American College of Cardiology, vol. 62, no. 5, pp. 468-476. https://doi.org/10.1016/j.jacc.2013.04.064

Optimized prognostic score for coronary computed tomographic angiography : Results from the CONFIRM registry (COronary CT angiography evaluation for clinical outcomes: An international multicenter registry). / Hadamitzky, Martin; Achenbach, Stephan; Al-Mallah, Mouaz; Berman, Daniel; Budoff, Matthew; Cademartiri, Filippo; Callister, Tracy; Chang, Hyuk Jae; Cheng, Victor; Chinnaiyan, Kavitha; Chow, Benjamin J.W.; Cury, Ricardo; Delago, Augustin; Dunning, Allison; Feuchtner, Gudrun; Gomez, Millie; Kaufmann, Philipp; Kim, Yong Jin; Leipsic, Jonathon; Lin, Fay Y.; Maffei, Erica; Min, James K.; Raff, Gil; Shaw, Leslee J.; Villines, Todd C.; Hausleiter, Jörg.

In: Journal of the American College of Cardiology, Vol. 62, No. 5, 30.07.2013, p. 468-476.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Optimized prognostic score for coronary computed tomographic angiography

T2 - Results from the CONFIRM registry (COronary CT angiography evaluation for clinical outcomes: An international multicenter registry)

AU - Hadamitzky, Martin

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Berman, Daniel

AU - Budoff, Matthew

AU - Cademartiri, Filippo

AU - Callister, Tracy

AU - Chang, Hyuk Jae

AU - Cheng, Victor

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo

AU - Delago, Augustin

AU - Dunning, Allison

AU - Feuchtner, Gudrun

AU - Gomez, Millie

AU - Kaufmann, Philipp

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Lin, Fay Y.

AU - Maffei, Erica

AU - Min, James K.

AU - Raff, Gil

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Hausleiter, Jörg

PY - 2013/7/30

Y1 - 2013/7/30

N2 - Objectives The aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with suspected coronary artery disease (CAD). Background Coronary computed tomography angiography carries important prognostic information in addition to the detection of obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk predictors. Methods The analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was modeled. The endpoint was all-cause mortality. Results During a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was the number of proximal segments with mixed or calcified plaques (C-index 0.64, p < 0.0001) and the number of proximal segments with a stenosis >50% (C-index 0.56, p = 0.002). In an optimized score including both parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or a stenosis >50% is equivalent to a 5-year increase in age or the risk of smoking. Conclusions In CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.

AB - Objectives The aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with suspected coronary artery disease (CAD). Background Coronary computed tomography angiography carries important prognostic information in addition to the detection of obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk predictors. Methods The analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was modeled. The endpoint was all-cause mortality. Results During a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was the number of proximal segments with mixed or calcified plaques (C-index 0.64, p < 0.0001) and the number of proximal segments with a stenosis >50% (C-index 0.56, p = 0.002). In an optimized score including both parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or a stenosis >50% is equivalent to a 5-year increase in age or the risk of smoking. Conclusions In CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.

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