Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events
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Published:2017-03
Issue:3
Volume:10
Page:
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ISSN:1941-9651
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Container-title:Circulation: Cardiovascular Imaging
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language:en
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Short-container-title:Circ: Cardiovascular Imaging
Author:
Naoum Christopher1, Berman Daniel S.1, Ahmadi Amir1, Blanke Philipp1, Gransar Heidi1, Narula Jagat1, Shaw Leslee J.1, Kritharides Leonard1, Achenbach Stephan1, Al-Mallah Mouaz H.1, Andreini Daniele1, Budoff Matthew J.1, Cademartiri Filippo1, Callister Tracy Q.1, Chang Hyuk-Jae1, Chinnaiyan Kavitha1, Chow Benjamin1, Cury Ricardo C.1, DeLago Augustin1, Dunning Allison1, Feuchtner Gudrun1, Hadamitzky Martin1, Hausleiter Joerg1, Kaufmann Philipp A.1, Kim Yong-Jin1, Maffei Erica1, Marquez Hugo1, Pontone Gianluca1, Raff Gilbert1, Rubinshtein Ronen1, Villines Todd C.1, Min James1, Leipsic Jonathon1
Affiliation:
1. From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine...
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:
R
2
=0.86±0.12; women:
R
2
=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.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01443637.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging
Cited by
29 articles.
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