Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM])

Donghee Han; Ashley Beecy; Khalil Anchouche; Heidi Gransar; Patricia C. Dunham; Ji Hyun Lee; Stephan Achenbach; Mouaz H. Al-Mallah; Daniele Andreini; Daniel S. Berman; Jeroen J. Bax; Matthew J. Budoff; Filippo Cademartiri; Tracy Q. Callister; Hyuk Jae Chang; Kavitha Chinnaiyan; Benjamin J.W. Chow; Ricardo C. Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A. Kaufmann; Yong Jin Kim; Jonathon A. Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L. Raff; Ronen Rubinshtein; Todd C. Villines; Yao Lu; Jessica M. Peña; Leslee J. Shaw; James K. Min; Fay Y. Lin

doi:10.1016/j.amjcard.2019.07.045

Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM])

Donghee Han, Ashley Beecy, Khalil Anchouche, Heidi Gransar, Patricia C. Dunham, Ji Hyun Lee, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Daniel S. Berman, Jeroen J. Bax, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin DeLago, Gudrun FeuchtnerMartin Hadamitzky, Joerg Hausleiter, Philipp A. Kaufmann, Yong Jin Kim, Jonathon A. Leipsic, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Gianluca Pontone, Gilbert L. Raff, Ronen Rubinshtein, Todd C. Villines, Yao Lu, Jessica M. Peña, Leslee J. Shaw, James K. Min, Fay Y. Lin

Department of Internal Medicine

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

10 Citations (Scopus)

Abstract

The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p >0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA.

Original language	English
Pages (from-to)	1397-1405
Number of pages	9
Journal	American Journal of Cardiology
Volume	124
Issue number	9
DOIs	https://doi.org/10.1016/j.amjcard.2019.07.045
Publication status	Published - 2019 Nov 1

Bibliographical note

Funding Information:
Funding: The research reported in this publication was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150. This research was also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA).

Funding Information:
Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Benjamin Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research. He receives research support from CV Diagnostix and Ausculsciences, educational support from TeraRecon Inc. and has equity interest in General Electric. Dr. Kavitha Chinnaiyan is a noncompensated medical advisory board member of Heartflow Inc. All other authors have no relevant disclosures.

Publisher Copyright:
© 2019

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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Han, D., Beecy, A., Anchouche, K., Gransar, H., Dunham, P. C., Lee, J. H., Achenbach, S., Al-Mallah, M. H., Andreini, D., Berman, D. S., Bax, J. J., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Chinnaiyan, K., Chow, B. J. W., Cury, R. C., DeLago, A., ... Lin, F. Y. (2019). Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM]). American Journal of Cardiology, 124(9), 1397-1405. https://doi.org/10.1016/j.amjcard.2019.07.045

Han, Donghee ; Beecy, Ashley ; Anchouche, Khalil et al. / Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM]). In: American Journal of Cardiology. 2019 ; Vol. 124, No. 9. pp. 1397-1405.

@article{d0f20ee5d88f4a93b5235624dd780402,

title = "Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM])",

abstract = "The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p >0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA.",

author = "Donghee Han and Ashley Beecy and Khalil Anchouche and Heidi Gransar and Dunham, {Patricia C.} and Lee, {Ji Hyun} and Stephan Achenbach and Al-Mallah, {Mouaz H.} and Daniele Andreini and Berman, {Daniel S.} and Bax, {Jeroen J.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Augustin DeLago and Gudrun Feuchtner and Martin Hadamitzky and Joerg Hausleiter and Kaufmann, {Philipp A.} and Kim, {Yong Jin} and Leipsic, {Jonathon A.} and Erica Maffei and Hugo Marques and {de Ara{\'u}jo Gon{\c c}alves}, Pedro and Gianluca Pontone and Raff, {Gilbert L.} and Ronen Rubinshtein and Villines, {Todd C.} and Yao Lu and Pe{\~n}a, {Jessica M.} and Shaw, {Leslee J.} and Min, {James K.} and Lin, {Fay Y.}",

note = "Funding Information: Funding: The research reported in this publication was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150. This research was also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA). Funding Information: Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Benjamin Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research. He receives research support from CV Diagnostix and Ausculsciences, educational support from TeraRecon Inc. and has equity interest in General Electric. Dr. Kavitha Chinnaiyan is a noncompensated medical advisory board member of Heartflow Inc. All other authors have no relevant disclosures. Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = nov,

day = "1",

doi = "10.1016/j.amjcard.2019.07.045",

language = "English",

volume = "124",

pages = "1397--1405",

journal = "American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier Inc.",

number = "9",

}

Han, D, Beecy, A, Anchouche, K, Gransar, H, Dunham, PC, Lee, JH, Achenbach, S, Al-Mallah, MH, Andreini, D, Berman, DS, Bax, JJ, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Chinnaiyan, K, Chow, BJW, Cury, RC, DeLago, A, Feuchtner, G, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Kim, YJ, Leipsic, JA, Maffei, E, Marques, H, de Araújo Gonçalves, P, Pontone, G, Raff, GL, Rubinshtein, R, Villines, TC, Lu, Y, Peña, JM, Shaw, LJ, Min, JK & Lin, FY 2019, 'Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM])', American Journal of Cardiology, vol. 124, no. 9, pp. 1397-1405. https://doi.org/10.1016/j.amjcard.2019.07.045

Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM]). / Han, Donghee; Beecy, Ashley; Anchouche, Khalil et al.

In: American Journal of Cardiology, Vol. 124, No. 9, 01.11.2019, p. 1397-1405.

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

TY - JOUR

T1 - Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM])

AU - Han, Donghee

AU - Beecy, Ashley

AU - Anchouche, Khalil

AU - Gransar, Heidi

AU - Dunham, Patricia C.

AU - Lee, Ji Hyun

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz H.

AU - Andreini, Daniele

AU - Berman, Daniel S.

AU - Bax, Jeroen J.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo C.

AU - DeLago, Augustin

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufmann, Philipp A.

AU - Kim, Yong Jin

AU - Leipsic, Jonathon A.

AU - Maffei, Erica

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Rubinshtein, Ronen

AU - Villines, Todd C.

AU - Lu, Yao

AU - Peña, Jessica M.

AU - Shaw, Leslee J.

AU - Min, James K.

AU - Lin, Fay Y.

N1 - Funding Information: Funding: The research reported in this publication was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150. This research was also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA). Funding Information: Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Benjamin Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research. He receives research support from CV Diagnostix and Ausculsciences, educational support from TeraRecon Inc. and has equity interest in General Electric. Dr. Kavitha Chinnaiyan is a noncompensated medical advisory board member of Heartflow Inc. All other authors have no relevant disclosures. Publisher Copyright: © 2019

PY - 2019/11/1

Y1 - 2019/11/1

N2 - The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p >0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA.

AB - The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p >0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA.

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