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

• Type of Material: Article
• Authors: Chaitu Cheruvu, University of British Columbia; Bruce Precious, University of British Columbia; Christopher Naoum, University of British Columbia; Philipp Blanke, University of British Columbia; Amir Ahmadi, University of British Columbia; Jeanette Soon, University of British Columbia; Chesnaldey Arepalli, University of British Columbia; Heidi Gransar, University of California Los Angeles; Stephan Achenbach, University of Erlangen; Daniel S. Berman, Cedars Sinai Medical Center; Matthew J. Budoff, Harbor UCLA Medical Center; Tracy Q. Callister, Tennessee Heart and Vascular Institute; Mouaz H. Al-Mallah, Wayne State University; Filippo Cademartiri, Giovanni XXIII Hospital; Kavitha Chinnaiyan, William Beaumont Hospital; Ronen Rubinshtein, Curry Cabral Hospital; Hugo Marquez, Technion-Israel Institute of Technology; Augustin DeLago, Capitol Cardiology Associates; Todd C. Villines, Walter Reed Medical Center; Martin Hadamitzky, Deutsches Herzzentrum Munchen; Joerg Hausleiter, Universität München; Leslee Shaw, Emory University; Philipp Kaufmann, University Hospital Zurich; Ricardo C. Cury, Baptist Cardiac and Vascular Institute; Gudrun Feuchtner, Medical University of Innsbruck; Yun Kim, Emory University; Erica Maffei, Giovanni XXIII Hospital; Gilbert Raff, William Beaumont Hospital; Gianluca Pontone, University of Milan; Daniele Andreini, University of Milan; Hyuk-Jae Chang, Yonsei University Health System; James K. Min, New York-Presbyterian Hospital; Jonathon Leipsic, University of British Columbia
• Language: English
• Date: 2016-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Society of Cardiovascular Computed Tomography.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcct.2015.12.005
• Title of Journal or Parent Work: Journal of Cardiovascular Computed Tomography
• ISSN: 1934-5925
• Volume: 10
• Issue: 1
• Start Page: 22
• End Page: 27
• Grant/Funding Information: Research reported in this publication was supported by the Heart Lung and Blood Institute of the National Institutes of Health under award numbers 1R01HL115150 and R011HL118019.; This study was also funded partly by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation.
• Keywords: All-cause mortality; Cardiac & Cardiovascular Systems; ATHEROSCLEROSIS; Coronary artery disease; Coronary computed tomographic angiography; Radiology, Nuclear Medicine & Medical Imaging; Science & Technology; EVENTS; CLINICAL-OUTCOMES; Major adverse cardiovascular events; SCORE; COMPUTED-TOMOGRAPHY ANGIOGRAPHY; Life Sciences & Biomedicine; Cardiovascular System & Cardiology
• Research Categories: Health Sciences, Radiology; Health Sciences, Medicine and Surgery

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.