Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Donghee Han, Bríain Ó Hartaigh, Heidi Gransar, Ji Hyun Lee, Asim Rizvi, Lohendran Baskaran, Joshua Schulman-Marcus, Allison Dunning, Stephan Achenbach, Mouaz H Al-Mallah, Daniel S Berman, Matthew J Budoff, Filippo Cademartiri, Erica Maffei, Tracy Q Callister, Kavitha Chinnaiyan, Benjamin J W Chow, Augustin DeLago, Martin Hadamitzky, Joerg HausleiterPhilipp A Kaufmann, Gilbert Raff, Leslee J Shaw, Todd C Villines, Yong-Jin Kim, Jonathon Leipsic, Gudrun Feuchtner, Ricardo C Cury, Gianluca Pontone, Daniele Andreini, Hugo Marques, Ronen Rubinshtein, Niree Hindoyan, Erica C Jones, Millie Gomez, Fay Y Lin, Hyuk-Jae Chang, James K Min

Research output: Contribution to journalArticle

Abstract

Aims: Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults.

Methods and results: Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles.

Conclusion: CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.

Original languageEnglish
JournalEuropean Heart Journal Cardiovascular Imaging
DOIs
Publication statusE-pub ahead of print - Jul 20 2017

Keywords

  • Journal Article

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    Han, D., Hartaigh, B. Ó., Gransar, H., Lee, J. H., Rizvi, A., Baskaran, L., Schulman-Marcus, J., Dunning, A., Achenbach, S., Al-Mallah, M. H., Berman, D. S., Budoff, M. J., Cademartiri, F., Maffei, E., Callister, T. Q., Chinnaiyan, K., Chow, B. J. W., DeLago, A., Hadamitzky, M., ... Min, J. K. (2017). Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. European Heart Journal Cardiovascular Imaging. https://doi.org/10.1093/ehjci/jex150