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Multicenter Study
. 2018 Mar 14;39(11):934-941.
doi: 10.1093/eurheartj/ehx774.

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  1   2   3 , Subhi J Al'Aref  1 , Adam Berger  4 , Bríain Ó Hartaigh  1 , Heidi Gransar  5 , Valentina Valenti  1 , Fay Y Lin  1 , Stephan Achenbach  5 , Daniel S Berman  6 , Matthew J Budoff  7 , Tracy Q Callister  8 , Mouaz H Al-Mallah  9 , Filippo Cademartiri  10 , Kavitha Chinnaiyan  11 , Benjamin J W Chow  12 , Augustin DeLago  13 , Todd C Villines  14 , Martin Hadamitzky  15 , Joerg Hausleiter  16 , Jonathon Leipsic  17 , Leslee J Shaw  4 , Philipp A Kaufmann  18 , Gudrun Feuchtner  19 , Yong-Jin Kim  20 , Erica Maffei  10 , Gilbert Raff  11 , Gianluca Pontone  21 , Daniele Andreini  21 , Hugo Marques  22 , Ronen Rubinshtein  23 , Hyuk-Jae Chang  2 , James K Min  1
Affiliations
Multicenter Study

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 et al. Eur Heart J. .

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 χ2 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.

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Figures

Figure 1
Figure 1
Risk of all-cause mortality according coronary computed tomographic angiography findings using unadjusted model and adjusted models for traditional risk factors. CI, confidence interval; CP, calcified plaque; HR, hazard ratio; N, number; NCP, non calcified plaque; MP, mixed plaque; VD, vessel disease.
See this image and copyright information in PMC

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