Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events

Christopher Naoum, Daniel S. Berman, Amir Ahmadi, Philipp Blanke, Heidi Gransar, Jagat Narula, Leslee J. Shaw, Leonard Kritharides, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin Chow, Ricardo C. Cury, Augustin DeLago, Allison DunningGudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp A. Kaufmann, Yong Jin Kim, Erica Maffei, Hugo Marquez, Gianluca Pontone, Gilbert Raff, Ronen Rubinshtein, Todd C. Villines, James Min, Jonathon Leipsic

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background-Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age-and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. Methods and Results-Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both). Conclusions-We have developed clinically pragmatic age-and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.

Original languageEnglish
Article numbere004896
JournalCirculation: Cardiovascular Imaging
Volume10
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

Fingerprint

Nomograms
Coronary Artery Disease
Confidence Intervals
Registries
Unstable Angina
Coronary Angiography
Chest Pain
Proportional Hazards Models
Cause of Death
Myocardial Infarction
Computed Tomography Angiography

Keywords

  • Computed tomography angiography
  • Coronary angiography
  • Coronary artery disease
  • Epidemiology
  • Nomograms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events. / Naoum, Christopher; Berman, Daniel S.; Ahmadi, Amir; Blanke, Philipp; Gransar, Heidi; Narula, Jagat; Shaw, Leslee J.; Kritharides, Leonard; Achenbach, Stephan; Al-Mallah, Mouaz H.; Andreini, Daniele; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Chinnaiyan, Kavitha; Chow, Benjamin; Cury, Ricardo C.; DeLago, Augustin; Dunning, Allison; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp A.; Kim, Yong Jin; Maffei, Erica; Marquez, Hugo; Pontone, Gianluca; Raff, Gilbert; Rubinshtein, Ronen; Villines, Todd C.; Min, James; Leipsic, Jonathon.

In: Circulation: Cardiovascular Imaging, Vol. 10, No. 3, e004896, 01.03.2017.

Research output: Contribution to journalArticle

Naoum, C, Berman, DS, Ahmadi, A, Blanke, P, Gransar, H, Narula, J, Shaw, LJ, Kritharides, L, Achenbach, S, Al-Mallah, MH, Andreini, D, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Chinnaiyan, K, Chow, B, Cury, RC, DeLago, A, Dunning, A, Feuchtner, G, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Kim, YJ, Maffei, E, Marquez, H, Pontone, G, Raff, G, Rubinshtein, R, Villines, TC, Min, J & Leipsic, J 2017, 'Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events', Circulation: Cardiovascular Imaging, vol. 10, no. 3, e004896. https://doi.org/10.1161/CIRCIMAGING.116.004896
Naoum, Christopher ; Berman, Daniel S. ; Ahmadi, Amir ; Blanke, Philipp ; Gransar, Heidi ; Narula, Jagat ; Shaw, Leslee J. ; Kritharides, Leonard ; Achenbach, Stephan ; Al-Mallah, Mouaz H. ; Andreini, Daniele ; Budoff, Matthew J. ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Chinnaiyan, Kavitha ; Chow, Benjamin ; Cury, Ricardo C. ; DeLago, Augustin ; Dunning, Allison ; Feuchtner, Gudrun ; Hadamitzky, Martin ; Hausleiter, Joerg ; Kaufmann, Philipp A. ; Kim, Yong Jin ; Maffei, Erica ; Marquez, Hugo ; Pontone, Gianluca ; Raff, Gilbert ; Rubinshtein, Ronen ; Villines, Todd C. ; Min, James ; Leipsic, Jonathon. / Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events. In: Circulation: Cardiovascular Imaging. 2017 ; Vol. 10, No. 3.
@article{c26ffeb3e354409ead9a23e0ef97ce1a,
title = "Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events",
abstract = "Background-Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age-and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. Methods and Results-Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46{\%} female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS{\%}) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44{\%} female) by stratifying patients into 3 SIS{\%} groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS{\%} groups. Annualized event rates were higher among patients with greater CAD burden (2.1{\%} [95{\%} confidence interval: 1.7{\%}-2.7{\%}], 3.9{\%} [95{\%} confidence interval: 3.0{\%}-5.1{\%}], and 7.2{\%} [95{\%} confidence interval: 5.4{\%}-9.6{\%}] in ≤50th, 51-75th, and >75th SIS{\%} groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS{\%} groups above the median compared with patients below the median (hazard ratio [95{\%} confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS{\%} group and 3.4 [2.3-5.0] for >75th SIS{\%} group; P<0.01 for both). Conclusions-We have developed clinically pragmatic age-and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS{\%} is predictive of cardiac events independent of traditional risk assessment.",
keywords = "Computed tomography angiography, Coronary angiography, Coronary artery disease, Epidemiology, Nomograms",
author = "Christopher Naoum and Berman, {Daniel S.} and Amir Ahmadi and Philipp Blanke and Heidi Gransar and Jagat Narula and Shaw, {Leslee J.} and Leonard Kritharides and Stephan Achenbach and Al-Mallah, {Mouaz H.} and Daniele Andreini and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kavitha Chinnaiyan and Benjamin Chow and Cury, {Ricardo C.} and Augustin DeLago and Allison Dunning and Gudrun Feuchtner and Martin Hadamitzky and Joerg Hausleiter and Kaufmann, {Philipp A.} and Kim, {Yong Jin} and Erica Maffei and Hugo Marquez and Gianluca Pontone and Gilbert Raff and Ronen Rubinshtein and Villines, {Todd C.} and James Min and Jonathon Leipsic",
year = "2017",
month = "3",
day = "1",
doi = "10.1161/CIRCIMAGING.116.004896",
language = "English",
volume = "10",
journal = "Circulation: Cardiovascular Imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events

AU - Naoum, Christopher

AU - Berman, Daniel S.

AU - Ahmadi, Amir

AU - Blanke, Philipp

AU - Gransar, Heidi

AU - Narula, Jagat

AU - Shaw, Leslee J.

AU - Kritharides, Leonard

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz H.

AU - Andreini, Daniele

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin

AU - Cury, Ricardo C.

AU - DeLago, Augustin

AU - Dunning, Allison

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufmann, Philipp A.

AU - Kim, Yong Jin

AU - Maffei, Erica

AU - Marquez, Hugo

AU - Pontone, Gianluca

AU - Raff, Gilbert

AU - Rubinshtein, Ronen

AU - Villines, Todd C.

AU - Min, James

AU - Leipsic, Jonathon

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background-Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age-and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. Methods and Results-Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both). Conclusions-We have developed clinically pragmatic age-and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.

AB - Background-Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age-and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. Methods and Results-Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both). Conclusions-We have developed clinically pragmatic age-and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.

KW - Computed tomography angiography

KW - Coronary angiography

KW - Coronary artery disease

KW - Epidemiology

KW - Nomograms

UR - http://www.scopus.com/inward/record.url?scp=85016204815&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016204815&partnerID=8YFLogxK

U2 - 10.1161/CIRCIMAGING.116.004896

DO - 10.1161/CIRCIMAGING.116.004896

M3 - Article

C2 - 28292858

AN - SCOPUS:85016204815

VL - 10

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

SN - 1941-9651

IS - 3

M1 - e004896

ER -