Studies examining coronary computed tomographic angiography (CCTA) have demonstrated increased mortality related to coronary artery disease (CAD) severity but are limited to relatively nondiverse ethnic populations. The aim of this study was to evaluate the prognostic significance of CAD on CCTA according to ethnicity for patients without previous CAD in a prospective international CCTA registry of 11 sites (7 countries) who underwent 64-slice CCTA from 2005 to 2010. CAD was defined as any coronary artery atherosclerosis and obstructive CAD as ≥50% stenosis. All-cause mortality and nonfatal myocardial infarction (MI) were assessed by ethnicity using Kaplan-Meier and Cox proportional hazards, controlling for baseline risk factors, medications, and revascularization. A total of 16,451 patients of mean age 58 years (55% men) were followed over a median of 2.0 years (interquartile range 1.4 to 3.2). Patients were 60.1% Caucasian, 34.4% East Asian, and 5.5% African. Death or MI occurred in 0.5% (38 of 7,109) among patients with no CAD, 1.6% (91 of 5,600) among those with nonobstructive CAD, and 3.8% (142 of 3,742) among those with ≥50% stenosis (p <0.001 among all groups). The annualized incidence of death or MI comparing obstructive to no obstructive CAD among Caucasians was 2.2% versus 0.7% (adjusted hazard ratio [aHR] 2.77, 95% confidence interval [CI] 1.73 to 4.43, p <0.001), among Africans 4.8% versus 1.1% (aHR 6.25, 95% CI 1.12 to 34.97, p = 0.037), and among East Asians 0.8% versus 0.1% (aHR 4.84, 95% CI 2.24 to 10.9, p <0.001). Compared to other ethnicities, East Asians had fewer than expected events (aHR 0.25, 95% CI 0.16 to 0.38, p <0.001). In conclusion, the presence and severity of CAD visualized by CCTA predict death or MI across 3 large ethnicities, whereas normal results on CCTA identify patients at very low risk.
Bibliographical noteFunding Information:
Dr. Villines has received speaker's honoraria from Boehringer-Ingelheim, Ingelheim, Germany. Dr. Achenbach has received grant support from Siemens Healthcare, Erlangen, Germany, and Bayer Schering Pharma AG, Berlin, Germany. Dr. Budoff has received speaker's honoraria from GE Healthcare, Milwaukee, Wisconsin. Dr. Cademartiri has received grant support from GE Healthcare and speaker's honoraria from Bracco Diagnostics, Milan, Italy. Dr. Callister is on the speaker's bureau of GE Healthcare. Dr. Chinnaiyan has received grant support from Bayer Pharma AG, Berlin, Germany, and Blue Cross Blue Shield Blue Care Michigan. Dr. Chow has received research support from GE Healthcare; Pfizer, Inc., New York, New York; and AstraZeneca, Wilmington, Delaware. Dr. Chow has recieved educational support from TeraRecon, Foster City, California. Dr. Hausleiter has received research grant support from Siemens Healthcare. Dr. Kaufmann has received research support from GE Healthcare and grant support from the Swiss National Science Foundation, Bern, Switzerland. Dr. Maffei has received grant support from GE Healthcare and is a consultant for Servier, Neuilly-sur-Seine, France. Dr. Raff has received grant support from Siemens Healthcare, Blue Cross Blue Shield Blue Care Michigan, and Bayer Pharma AG. Dr. Min has received speaker's honoraria and research support from and serves on the medical advisory board of GE Healthcare. The views expressed here are those of the investigators only and are not to be construed as those of the United States Department of the Army or Department of Defense.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine