Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: A 6-year follow-up from the prospective multicentre international CONFIRM study

Iksung Cho, Subhi J. Al'aref, Adam Berger, Bríain Ó Hartaigh, Heidi Gransar, Valentina Valenti, Fay Y. Lin, Stephan Achenbach, Daniel S. Berman, Matthew J. Budoff, Tracy Q. Callister, Mouaz H. Al-Mallah, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J.W. Chow, Augustin Delago, Todd C. Villines, Martin Hadamitzky, Joerg Hausleiter, Jonathon LeipsicLeslee J. Shaw, Philipp A. Kaufmann, Gudrun Feuchtner, Yong Jin Kim, Erica Maffei, Gilbert Raff, Gianluca Pontone, Daniele Andreini, Hugo Marques, Ronen Rubinshtein, Hyuk Jae Chang, James K. Min

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Abstract

Aim The long-term prognostic benefit of coronary computed tomographic angiography (CCTA) findings of coronary artery disease (CAD) in asymptomatic populations is unknown. Methods and results From the prospective multicentre international CONFIRM long-term study, we evaluated asymptomatic subjects without known CAD who underwent both coronary artery calcium scoring (CACS) and CCTA (n = 1226). Coronary computed tomographic angiography findings included the severity of coronary artery stenosis, plaque composition, and coronary segment location. Using the C-statistic and likelihood ratio tests, we evaluated the incremental prognostic utility of CCTA findings over a base model that included a panel of traditional risk factors (RFs) as well as CACS to predict long-term all-cause mortality. During a mean follow-up of 5.9 ± 1.2 years, 78 deaths occurred. Compared with the traditional RF alone (C-statistic 0.64), CCTA findings including coronary stenosis severity, plaque composition, and coronary segment location demonstrated improved incremental prognostic utility beyond traditional RF alone (C-statistics range 0.71-0.73, all P < 0.05; incremental v2 range 20.7-25.5, all P < 0.001). However, no added prognostic benefit was offered by CCTA findings when added to a base model containing both traditional RF and CACS (C-statistics P > 0.05, for all). Conclusions Coronary computed tomographic angiography improved prognostication of 6-year all-cause mortality beyond a set of conventional RF alone, although, no further incremental value was offered by CCTA when CCTA findings were added to a model incorporating RF and CACS.

Original languageEnglish
Pages (from-to)934-941
Number of pages8
JournalEuropean heart journal
Volume39
Issue number11
DOIs
Publication statusPublished - 2018 Mar 14

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Cho, I., Al'aref, S. J., Berger, A., Ó Hartaigh, B., Gransar, H., Valenti, V., Lin, F. Y., Achenbach, S., Berman, D. S., Budoff, M. J., Callister, T. Q., Al-Mallah, M. H., Cademartiri, F., Chinnaiyan, K., Chow, B. J. W., Delago, A., Villines, T. C., Hadamitzky, M., Hausleiter, J., ... Min, J. K. (2018). Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: A 6-year follow-up from the prospective multicentre international CONFIRM study. European heart journal, 39(11), 934-941. https://doi.org/10.1093/eurheartj/ehx774