Incremental Prognostic Value of Cardiac Computed Tomography in Coronary Artery Disease Using CONFIRM

Author:

Chow Benjamin J.W.1,Small Gary1,Yam Yeung1,Chen Li1,Achenbach Stephan1,Al-Mallah Mouaz1,Berman Daniel S.1,Budoff Matthew J.1,Cademartiri Filippo1,Callister Tracy Q.1,Chang Hyuk-Jae1,Cheng Victor1,Chinnaiyan Kavitha M.1,Delago Augustin1,Dunning Allison1,Hadamitzky Martin1,Hausleiter Jörg1,Kaufmann Philipp1,Lin Fay1,Maffei Erica1,Raff Gilbert L.1,Shaw Leslee J.1,Villines Todd C.1,Min James K.1

Affiliation:

1. From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,...

Abstract

Background— Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables. Methods and Results— A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non–high-risk, or high-risk CAD) and LVEF <50%. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3%) patients (mean follow-up of 22.5 months; 95% confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65% of patients without coronary atherosclerosis, 1.99% of patients with nonobstructive CAD, 2.90% of patients with non–high-risk CAD, and 4.95% for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50% (hazard ratio, 2.74; 95% confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95% confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables. Conclusions— Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3