Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: a 6-year follow-up from the prospective multicentre international CONFIRM study

Iksung Cho, Subhi J Al'Aref, Adam Berger, Bríain Ó Hartaigh, Heidi Gransar, Valentina Valenti, Fay Y Lin, Stephan Achenbach, Daniel S Berman, Matthew J Budoff, Tracy Q Callister, Mouaz H Al-Mallah, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J W Chow, Augustin DeLago, Todd C Villines, Martin Hadamitzky, Joerg Hausleiter, Jonathon LeipsicLeslee J Shaw, Philipp A Kaufmann, Gudrun Feuchtner, Yong-Jin Kim, Erica Maffei, Gilbert Raff, Gianluca Pontone, Daniele Andreini, Hugo Marques, Ronen Rubinshtein, Hyuk-Jae Chang, James K Min

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: The long-term prognostic benefit of coronary computed tomographic angiography (CCTA) findings of coronary artery disease (CAD) in asymptomatic populations is unknown.

Methods and results: From the prospective multicentre international CONFIRM long-term study, we evaluated asymptomatic subjects without known CAD who underwent both coronary artery calcium scoring (CACS) and CCTA (n = 1226). Coronary computed tomographic angiography findings included the severity of coronary artery stenosis, plaque composition, and coronary segment location. Using the C-statistic and likelihood ratio tests, we evaluated the incremental prognostic utility of CCTA findings over a base model that included a panel of traditional risk factors (RFs) as well as CACS to predict long-term all-cause mortality. During a mean follow-up of 5.9 ± 1.2 years, 78 deaths occurred. Compared with the traditional RF alone (C-statistic 0.64), CCTA findings including coronary stenosis severity, plaque composition, and coronary segment location demonstrated improved incremental prognostic utility beyond traditional RF alone (C-statistics range 0.71-0.73, all P < 0.05; incremental χ2 range 20.7-25.5, all P < 0.001). However, no added prognostic benefit was offered by CCTA findings when added to a base model containing both traditional RF and CACS (C-statistics P > 0.05, for all).

Conclusions: Coronary computed tomographic angiography improved prognostication of 6-year all-cause mortality beyond a set of conventional RF alone, although, no further incremental value was offered by CCTA when CCTA findings were added to a model incorporating RF and CACS.

Original languageEnglish
Pages (from-to)934-941
Number of pages8
JournalEuropean Heart Journal
Volume39
Issue number11
DOIs
Publication statusPublished - Mar 14 2018

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