Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD

Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study

Daniele Andreini, Gianluca Pontone, Saima Mushtaq, Heidi Gransar, Edoardo Conte, Antonio L Bartorelli, Mauro Pepi, Maksymilian P. Opolski, Bríain Ó Hartaigh, Daniel S. Berman, Matthew J. Budoff, Stephan Achenbach, Mouaz Al-Mallah, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J W Chow, Ricardo C. Cury, Augustin DeLago & 17 others Martin Hadamitzky, Joerg Hausleiter, Gudrun Feuchtner, Yong Jin Kim, Philipp A. Kaufmann, Jonathon Leipsic, Fay Y. Lin, Erica Maffei, Gilbert Raff, Leslee J. Shaw, Todd C. Villines, Allison Dunning, Hugo Marques, Ronen Rubinshtein, Niree Hindoyan, Millie J. Gomez, James K. Min

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Abstract

BACKGROUND: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD).

METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality.

RESULTS: Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not.

CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.

Original languageEnglish
Pages (from-to)18-25
Number of pages8
JournalInternational Journal of Cardiology
Volume231
DOIs
Publication statusPublished - Mar 15 2017

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Coronary Angiography
Multicenter Studies
Coronary Artery Disease
Myocardial Infarction
Mortality
Computed Tomography Angiography
Cause of Death
Pathologic Constriction

Keywords

  • Journal Article

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Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD : Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study. / Andreini, Daniele; Pontone, Gianluca; Mushtaq, Saima; Gransar, Heidi; Conte, Edoardo; Bartorelli, Antonio L; Pepi, Mauro; Opolski, Maksymilian P.; Ó Hartaigh, Bríain; Berman, Daniel S.; Budoff, Matthew J.; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; Cury, Ricardo C.; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Feuchtner, Gudrun; Kim, Yong Jin; Kaufmann, Philipp A.; Leipsic, Jonathon; Lin, Fay Y.; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J.; Villines, Todd C.; Dunning, Allison; Marques, Hugo; Rubinshtein, Ronen; Hindoyan, Niree; Gomez, Millie J.; Min, James K.

In: International Journal of Cardiology, Vol. 231, 15.03.2017, p. 18-25.

Research output: Contribution to journalArticle

Andreini, D, Pontone, G, Mushtaq, S, Gransar, H, Conte, E, Bartorelli, AL, Pepi, M, Opolski, MP, Ó Hartaigh, B, Berman, DS, Budoff, MJ, Achenbach, S, Al-Mallah, M, Cademartiri, F, Callister, TQ, Chang, HJ, Chinnaiyan, K, Chow, BJW, Cury, RC, DeLago, A, Hadamitzky, M, Hausleiter, J, Feuchtner, G, Kim, YJ, Kaufmann, PA, Leipsic, J, Lin, FY, Maffei, E, Raff, G, Shaw, LJ, Villines, TC, Dunning, A, Marques, H, Rubinshtein, R, Hindoyan, N, Gomez, MJ & Min, JK 2017, 'Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study', International Journal of Cardiology, vol. 231, pp. 18-25. https://doi.org/10.1016/j.ijcard.2016.12.137
Andreini, Daniele ; Pontone, Gianluca ; Mushtaq, Saima ; Gransar, Heidi ; Conte, Edoardo ; Bartorelli, Antonio L ; Pepi, Mauro ; Opolski, Maksymilian P. ; Ó Hartaigh, Bríain ; Berman, Daniel S. ; Budoff, Matthew J. ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Chinnaiyan, Kavitha ; Chow, Benjamin J W ; Cury, Ricardo C. ; DeLago, Augustin ; Hadamitzky, Martin ; Hausleiter, Joerg ; Feuchtner, Gudrun ; Kim, Yong Jin ; Kaufmann, Philipp A. ; Leipsic, Jonathon ; Lin, Fay Y. ; Maffei, Erica ; Raff, Gilbert ; Shaw, Leslee J. ; Villines, Todd C. ; Dunning, Allison ; Marques, Hugo ; Rubinshtein, Ronen ; Hindoyan, Niree ; Gomez, Millie J. ; Min, James K. / Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD : Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study. In: International Journal of Cardiology. 2017 ; Vol. 231. pp. 18-25.
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title = "Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study",
abstract = "BACKGROUND: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD).METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50{\%} stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality.RESULTS: Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not.CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.",
keywords = "Journal Article",
author = "Daniele Andreini and Gianluca Pontone and Saima Mushtaq and Heidi Gransar and Edoardo Conte and Bartorelli, {Antonio L} and Mauro Pepi and Opolski, {Maksymilian P.} and {{\'O} Hartaigh}, Br{\'i}ain and Berman, {Daniel S.} and Budoff, {Matthew J.} and Stephan Achenbach and Mouaz Al-Mallah and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kavitha Chinnaiyan and Chow, {Benjamin J W} and Cury, {Ricardo C.} and Augustin DeLago and Martin Hadamitzky and Joerg Hausleiter and Gudrun Feuchtner and Kim, {Yong Jin} and Kaufmann, {Philipp A.} and Jonathon Leipsic and Lin, {Fay Y.} and Erica Maffei and Gilbert Raff and Shaw, {Leslee J.} and Villines, {Todd C.} and Allison Dunning and Hugo Marques and Ronen Rubinshtein and Niree Hindoyan and Gomez, {Millie J.} and Min, {James K.}",
note = "Copyright {\circledC} 2016 Elsevier Ireland Ltd. All rights reserved.",
year = "2017",
month = "3",
day = "15",
doi = "10.1016/j.ijcard.2016.12.137",
language = "English",
volume = "231",
pages = "18--25",
journal = "International Journal of Cardiology",
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TY - JOUR

T1 - Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD

T2 - Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study

AU - Andreini, Daniele

AU - Pontone, Gianluca

AU - Mushtaq, Saima

AU - Gransar, Heidi

AU - Conte, Edoardo

AU - Bartorelli, Antonio L

AU - Pepi, Mauro

AU - Opolski, Maksymilian P.

AU - Ó Hartaigh, Bríain

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J W

AU - Cury, Ricardo C.

AU - DeLago, Augustin

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Feuchtner, Gudrun

AU - Kim, Yong Jin

AU - Kaufmann, Philipp A.

AU - Leipsic, Jonathon

AU - Lin, Fay Y.

AU - Maffei, Erica

AU - Raff, Gilbert

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Dunning, Allison

AU - Marques, Hugo

AU - Rubinshtein, Ronen

AU - Hindoyan, Niree

AU - Gomez, Millie J.

AU - Min, James K.

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2017/3/15

Y1 - 2017/3/15

N2 - BACKGROUND: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD).METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality.RESULTS: Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not.CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.

AB - BACKGROUND: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD).METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality.RESULTS: Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not.CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.

KW - Journal Article

U2 - 10.1016/j.ijcard.2016.12.137

DO - 10.1016/j.ijcard.2016.12.137

M3 - Article

VL - 231

SP - 18

EP - 25

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -