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Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry.
J Cardiovasc Comput Tomogr. 2016 Jan-Feb; 10(1):22-7.JC

Abstract

BACKGROUND

Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE).

OBJECTIVE

Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE.

METHODS

From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days).

RESULTS

Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend.

CONCLUSIONS

In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period.

Authors+Show Affiliations

Department of Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Medicine, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.Department of Medicine, University of Erlangen, Erlangen, Germany.Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.William Beaumont Hospital, Royal Oaks, MI, USA.Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.Capitol Cardiology Associates, Albany, NY, USA.Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.University Hospital, Zurich, Switzerland.Baptist Cardiac and Vascular Institute, Miami, FL, USA.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Seoul National University Hospital, Seoul, South Korea.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.William Beaumont Hospital, Royal Oaks, MI, USA.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada. Electronic address: jleipsic@providencehealth.bc.ca.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26719237

Citation

Cheruvu, Chaitu, et al. "Long Term Prognostic Utility of Coronary CT Angiography in Patients With No Modifiable Coronary Artery Disease Risk Factors: Results From the 5 Year Follow-up of the CONFIRM International Multicenter Registry." Journal of Cardiovascular Computed Tomography, vol. 10, no. 1, 2016, pp. 22-7.
Cheruvu C, Precious B, Naoum C, et al. Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry. J Cardiovasc Comput Tomogr. 2016;10(1):22-7.
Cheruvu, C., Precious, B., Naoum, C., Blanke, P., Ahmadi, A., Soon, J., Arepalli, C., Gransar, H., Achenbach, S., Berman, D. S., Budoff, M. J., Callister, T. Q., Al-Mallah, M. H., Cademartiri, F., Chinnaiyan, K., Rubinshtein, R., Marquez, H., DeLago, A., Villines, T. C., ... Leipsic, J. (2016). Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry. Journal of Cardiovascular Computed Tomography, 10(1), 22-7. https://doi.org/10.1016/j.jcct.2015.12.005
Cheruvu C, et al. Long Term Prognostic Utility of Coronary CT Angiography in Patients With No Modifiable Coronary Artery Disease Risk Factors: Results From the 5 Year Follow-up of the CONFIRM International Multicenter Registry. J Cardiovasc Comput Tomogr. 2016 Jan-Feb;10(1):22-7. PubMed PMID: 26719237.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry. AU - Cheruvu,Chaitu, AU - Precious,Bruce, AU - Naoum,Christopher, AU - Blanke,Philipp, AU - Ahmadi,Amir, AU - Soon,Jeanette, AU - Arepalli,Chesnaldey, AU - Gransar,Heidi, AU - Achenbach,Stephan, AU - Berman,Daniel S, AU - Budoff,Matthew J, AU - Callister,Tracy Q, AU - Al-Mallah,Mouaz H, AU - Cademartiri,Filippo, AU - Chinnaiyan,Kavitha, AU - Rubinshtein,Ronen, AU - Marquez,Hugo, AU - DeLago,Augustin, AU - Villines,Todd C, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Shaw,Leslee J, AU - Kaufmann,Philipp A, AU - Cury,Ricardo C, AU - Feuchtner,Gudrun, AU - Kim,Yong-Jin, AU - Maffei,Erica, AU - Raff,Gilbert, AU - Pontone,Gianluca, AU - Andreini,Daniele, AU - Chang,Hyuk-Jae, AU - Min,James K, AU - Leipsic,Jonathon, Y1 - 2015/12/15/ PY - 2015/08/05/received PY - 2015/12/04/revised PY - 2015/12/11/accepted PY - 2016/1/1/entrez PY - 2016/1/1/pubmed PY - 2016/10/16/medline KW - All-cause mortality KW - Coronary artery disease KW - Coronary computed tomographic angiography KW - Major adverse cardiovascular events SP - 22 EP - 7 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 10 IS - 1 N2 - BACKGROUND: Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE). OBJECTIVE: Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE. METHODS: From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days). RESULTS: Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend. CONCLUSIONS: In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/26719237/Long_term_prognostic_utility_of_coronary_CT_angiography_in_patients_with_no_modifiable_coronary_artery_disease_risk_factors:_Results_from_the_5_year_follow_up_of_the_CONFIRM_International_Multicenter_Registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(15)30025-3 DB - PRIME DP - Unbound Medicine ER -