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Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM Registry (coronary CT angiography evaluation for clinical outcomes: an international multicenter registry).
Circulation. 2012 Jul 17; 126(3):304-13.Circ

Abstract

BACKGROUND

The predictive value of coronary computed tomographic angiography (cCTA) in subjects without chest pain syndrome (CPS) has not been established. We investigated the prognostic value of coronary artery disease detection by cCTA and determined the incremental risk stratification benefit of cCTA findings compared with clinical risk factor scoring and coronary artery calcium scoring (CACS) for individuals without CPS.

METHODS AND RESULTS

An open-label, 12-center, 6-country observational registry of 27 125 consecutive patients undergoing cCTA and CACS was queried, and 7590 individuals without CPS or history of coronary artery disease met the inclusion criteria. All-cause mortality and the composite of all-cause mortality and nonfatal myocardial infarction were measured. During a median follow-up of 24 months (interquartile range, 18-35 months), all-cause mortality occurred in 136 individuals. After risk adjustment, compared with individuals without evidence of coronary artery disease by cCTA, individuals with obstructive 2- and 3-vessel disease or left main coronary artery disease experienced higher rates of death and composite outcome (P<0.05 for both). Both CACS and cCTA significantly improved the performance of standard risk factor prediction models for all-cause mortality and the composite outcome (likelihood ratio P<0.05 for all), but the incremental discriminatory value associated with their inclusion was more pronounced for the composite outcome and for CACS (C statistic for model with risk factors only was 0.71; for risk factors plus CACS, 0.75; for risk factors plus CACS plus cCTA, 0.77). The net reclassification improvement resulting from the addition of cCTA to a model based on standard risk factors and CACS was negligible.

CONCLUSIONS

Although the prognosis for individuals without CPS is stratified by cCTA, the additional risk-predictive advantage by cCTA is not clinically meaningful compared with a risk model based on CACS. Therefore, at present, the application of cCTA for risk assessment of individuals without CPS should not be justified.

Authors+Show Affiliations

Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22685117

Citation

Cho, Iksung, et al. "Coronary Computed Tomographic Angiography and Risk of All-cause Mortality and Nonfatal Myocardial Infarction in Subjects Without Chest Pain Syndrome From the CONFIRM Registry (coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter Registry)." Circulation, vol. 126, no. 3, 2012, pp. 304-13.
Cho I, Chang HJ, Sung JM, et al. Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM Registry (coronary CT angiography evaluation for clinical outcomes: an international multicenter registry). Circulation. 2012;126(3):304-13.
Cho, I., Chang, H. J., Sung, J. M., Pencina, M. J., Lin, F. Y., Dunning, A. M., Achenbach, S., Al-Mallah, M., Berman, D. S., Budoff, M. J., Callister, T. Q., Chow, B. J., Delago, A., Hadamitzky, M., Hausleiter, J., Maffei, E., Cademartiri, F., Kaufmann, P., Shaw, L. J., ... Min, J. K. (2012). Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM Registry (coronary CT angiography evaluation for clinical outcomes: an international multicenter registry). Circulation, 126(3), 304-13. https://doi.org/10.1161/CIRCULATIONAHA.111.081380
Cho I, et al. Coronary Computed Tomographic Angiography and Risk of All-cause Mortality and Nonfatal Myocardial Infarction in Subjects Without Chest Pain Syndrome From the CONFIRM Registry (coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter Registry). Circulation. 2012 Jul 17;126(3):304-13. PubMed PMID: 22685117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM Registry (coronary CT angiography evaluation for clinical outcomes: an international multicenter registry). AU - Cho,Iksung, AU - Chang,Hyuk-Jae, AU - Sung,Ji Min, AU - Pencina,Michael J, AU - Lin,Fay Y, AU - Dunning,Allison M, AU - Achenbach,Stephan, AU - Al-Mallah,Mouaz, AU - Berman,Daniel S, AU - Budoff,Matthew J, AU - Callister,Tracy Q, AU - Chow,Benjamin J W, AU - Delago,Augustin, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Maffei,Erica, AU - Cademartiri,Filippo, AU - Kaufmann,Philipp, AU - Shaw,Leslee J, AU - Raff,Gil L, AU - Chinnaiyan,Kavitha M, AU - Villines,Todd C, AU - Cheng,Victor, AU - Nasir,Khurram, AU - Gomez,Millie, AU - Min,James K, AU - ,, Y1 - 2012/06/09/ PY - 2012/6/12/entrez PY - 2012/6/12/pubmed PY - 2012/10/4/medline SP - 304 EP - 13 JF - Circulation JO - Circulation VL - 126 IS - 3 N2 - BACKGROUND: The predictive value of coronary computed tomographic angiography (cCTA) in subjects without chest pain syndrome (CPS) has not been established. We investigated the prognostic value of coronary artery disease detection by cCTA and determined the incremental risk stratification benefit of cCTA findings compared with clinical risk factor scoring and coronary artery calcium scoring (CACS) for individuals without CPS. METHODS AND RESULTS: An open-label, 12-center, 6-country observational registry of 27 125 consecutive patients undergoing cCTA and CACS was queried, and 7590 individuals without CPS or history of coronary artery disease met the inclusion criteria. All-cause mortality and the composite of all-cause mortality and nonfatal myocardial infarction were measured. During a median follow-up of 24 months (interquartile range, 18-35 months), all-cause mortality occurred in 136 individuals. After risk adjustment, compared with individuals without evidence of coronary artery disease by cCTA, individuals with obstructive 2- and 3-vessel disease or left main coronary artery disease experienced higher rates of death and composite outcome (P<0.05 for both). Both CACS and cCTA significantly improved the performance of standard risk factor prediction models for all-cause mortality and the composite outcome (likelihood ratio P<0.05 for all), but the incremental discriminatory value associated with their inclusion was more pronounced for the composite outcome and for CACS (C statistic for model with risk factors only was 0.71; for risk factors plus CACS, 0.75; for risk factors plus CACS plus cCTA, 0.77). The net reclassification improvement resulting from the addition of cCTA to a model based on standard risk factors and CACS was negligible. CONCLUSIONS: Although the prognosis for individuals without CPS is stratified by cCTA, the additional risk-predictive advantage by cCTA is not clinically meaningful compared with a risk model based on CACS. Therefore, at present, the application of cCTA for risk assessment of individuals without CPS should not be justified. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/22685117/Coronary_computed_tomographic_angiography_and_risk_of_all_cause_mortality_and_nonfatal_myocardial_infarction_in_subjects_without_chest_pain_syndrome_from_the_CONFIRM_Registry__coronary_CT_angiography_evaluation_for_clinical_outcomes:_an_international_multicenter_registry__ DB - PRIME DP - Unbound Medicine ER -