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

Chaitu Cheruvu, Bruce Precious, Christopher Naoum, Philipp Blanke, Amir Ahmadi, Jeanette Soon, Chesnaldey Arepalli, Heidi Gransar, Stephan Achenbach, Daniel S. Berman, Matthew J. Budoff, Tracy Q. Callister, Mouaz H. Al-Mallah, Filippo Cademartiri, Kavitha Chinnaiyan, Ronen Rubinshtein, Hugo Marquez, Augustin DeLago, Todd C. Villines, Martin HadamitzkyJoerg Hausleiter, Leslee J. Shaw, Philipp A. Kaufmann, Ricardo C. Cury, Gudrun Feuchtner, Yong Jin Kim, Erica Maffei, Gilbert Raff, Gianluca Pontone, Daniele Andreini, Hyuk Jae Chang, James K. Min, Jonathon Leipsic

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)22-27
Number of pages6
JournalJournal of Cardiovascular Computed Tomography
Volume10
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

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Coronary Angiography
Registries
Coronary Artery Disease
Confidence Intervals
Pathologic Constriction
Mortality
Computed Tomography Angiography
Unstable Angina
Coronary Vessels
Myocardial Infarction

Keywords

  • All-cause mortality
  • Coronary artery disease
  • Coronary computed tomographic angiography
  • Major adverse cardiovascular events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

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. / Cheruvu, Chaitu; Precious, Bruce; Naoum, Christopher; Blanke, Philipp; Ahmadi, Amir; Soon, Jeanette; Arepalli, Chesnaldey; Gransar, Heidi; Achenbach, Stephan; Berman, Daniel S.; Budoff, Matthew J.; Callister, Tracy Q.; Al-Mallah, Mouaz H.; Cademartiri, Filippo; Chinnaiyan, Kavitha; Rubinshtein, Ronen; Marquez, Hugo; DeLago, Augustin; Villines, Todd C.; Hadamitzky, Martin; Hausleiter, Joerg; Shaw, Leslee J.; Kaufmann, Philipp A.; Cury, Ricardo C.; Feuchtner, Gudrun; Kim, Yong Jin; Maffei, Erica; Raff, Gilbert; Pontone, Gianluca; Andreini, Daniele; Chang, Hyuk Jae; Min, James K.; Leipsic, Jonathon.

In: Journal of Cardiovascular Computed Tomography, Vol. 10, No. 1, 01.01.2016, p. 22-27.

Research output: Contribution to journalArticle

Cheruvu, C, Precious, B, Naoum, C, Blanke, P, Ahmadi, A, Soon, J, Arepalli, C, Gransar, H, Achenbach, S, Berman, DS, Budoff, MJ, Callister, TQ, Al-Mallah, MH, Cademartiri, F, Chinnaiyan, K, Rubinshtein, R, Marquez, H, DeLago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Shaw, LJ, Kaufmann, PA, Cury, RC, Feuchtner, G, Kim, YJ, Maffei, E, Raff, G, Pontone, G, Andreini, D, Chang, HJ, Min, JK & 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, vol. 10, no. 1, pp. 22-27. https://doi.org/10.1016/j.jcct.2015.12.005
Cheruvu, Chaitu ; Precious, Bruce ; Naoum, Christopher ; Blanke, Philipp ; Ahmadi, Amir ; Soon, Jeanette ; Arepalli, Chesnaldey ; Gransar, Heidi ; Achenbach, Stephan ; Berman, Daniel S. ; Budoff, Matthew J. ; Callister, Tracy Q. ; Al-Mallah, Mouaz H. ; Cademartiri, Filippo ; Chinnaiyan, Kavitha ; Rubinshtein, Ronen ; Marquez, Hugo ; DeLago, Augustin ; Villines, Todd C. ; Hadamitzky, Martin ; Hausleiter, Joerg ; Shaw, Leslee J. ; Kaufmann, Philipp A. ; Cury, Ricardo C. ; Feuchtner, Gudrun ; Kim, Yong Jin ; Maffei, Erica ; Raff, Gilbert ; Pontone, Gianluca ; Andreini, Daniele ; Chang, Hyuk Jae ; Min, James K. ; Leipsic, Jonathon. / 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. In: Journal of Cardiovascular Computed Tomography. 2016 ; Vol. 10, No. 1. pp. 22-27.
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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.",
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author = "Chaitu Cheruvu and Bruce Precious and Christopher Naoum and Philipp Blanke and Amir Ahmadi and Jeanette Soon and Chesnaldey Arepalli and Heidi Gransar and Stephan Achenbach and Berman, {Daniel S.} and Budoff, {Matthew J.} and Callister, {Tracy Q.} and Al-Mallah, {Mouaz H.} and Filippo Cademartiri and Kavitha Chinnaiyan and Ronen Rubinshtein and Hugo Marquez and Augustin DeLago and Villines, {Todd C.} and Martin Hadamitzky and Joerg Hausleiter and Shaw, {Leslee J.} and Kaufmann, {Philipp A.} and Cury, {Ricardo C.} and Gudrun Feuchtner and Kim, {Yong Jin} and Erica Maffei and Gilbert Raff and Gianluca Pontone and Daniele Andreini and Chang, {Hyuk Jae} and Min, {James K.} and Jonathon Leipsic",
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TY - JOUR

T1 - Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors

T2 - 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

PY - 2016/1/1

Y1 - 2016/1/1

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.

AB - 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.

KW - All-cause mortality

KW - Coronary artery disease

KW - Coronary computed tomographic angiography

KW - Major adverse cardiovascular events

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