Long-term prognostic utility of computed tomography coronary angiography in older populations

Sonali R. Gnanenthiran; Christopher Naoum; Jonathon A. Leipsic; Stephan Achenbach; Mouaz H. Al-Mallah; Daniele Andreini; Jeroen J. Bax; Daniel S. Berman; Matthew J. Budoff; Filippo Cademartiri; Tracy Q. Callister; Hyuk Jae Chang; Kavitha Chinnaiyan; Benjamin J.W. Chow; Ricardo C. Cury; Augustin Delago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A. Kaufman; Yong Jin Kim; Erica Maffei; Hugo Marques; Pedro De Araújo Goncalves; Gianluca Pontone; Gilbert L. Raff; Ronen Rubinshtein; Leslee J. Shaw; Todd C. Villines; Heidi Gransar; Yao Lu; Erica C. Jones; Jessica M. Penã; Fay Y. Lin; Leonard Kritharides; James K. Min

doi:10.1093/ehjci/jez067

Long-term prognostic utility of computed tomography coronary angiography in older populations

Sonali R. Gnanenthiran, Christopher Naoum, Jonathon A. Leipsic, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Jeroen J. Bax, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin Delago, Gudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp A. KaufmanYong Jin Kim, Erica Maffei, Hugo Marques, Pedro De Araújo Goncalves, Gianluca Pontone, Gilbert L. Raff, Ronen Rubinshtein, Leslee J. Shaw, Todd C. Villines, Heidi Gransar, Yao Lu, Erica C. Jones, Jessica M. Penã, Fay Y. Lin, Leonard Kritharides, James K. Min

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Abstract

Aims: The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations. Methods and results: From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: None, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): Number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD. Conclusion: The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.

Original language	English
Pages (from-to)	1279-1286
Number of pages	8
Journal	European Heart Journal Cardiovascular Imaging
Volume	20
Issue number	11
DOIs	https://doi.org/10.1093/ehjci/jez067
State	Published - 1 Nov 2019

Keywords

age
coronary computed tomography angiography
major adverse cardiovascular events
mortality
older populations

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Gnanenthiran, S. R., Naoum, C., Leipsic, J. A., Achenbach, S., Al-Mallah, M. H., Andreini, D., Bax, J. J., Berman, D. S., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Chinnaiyan, K., Chow, B. J. W., Cury, R. C., Delago, A., Feuchtner, G., Hadamitzky, M., Hausleiter, J., ... Min, J. K. (2019). Long-term prognostic utility of computed tomography coronary angiography in older populations. European Heart Journal Cardiovascular Imaging, 20(11), 1279-1286. https://doi.org/10.1093/ehjci/jez067

@article{1c5a4698b4ea4038830c0c4a4642cede,

title = "Long-term prognostic utility of computed tomography coronary angiography in older populations",

abstract = "Aims: The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations. Methods and results: From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: None, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): Number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD. Conclusion: The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.",

keywords = "age, coronary computed tomography angiography, major adverse cardiovascular events, mortality, older populations",

author = "Gnanenthiran, {Sonali R.} and Christopher Naoum and Leipsic, {Jonathon A.} and Stephan Achenbach and Al-Mallah, {Mouaz H.} and Daniele Andreini and Bax, {Jeroen J.} and Berman, {Daniel S.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Augustin Delago and Gudrun Feuchtner and Martin Hadamitzky and Joerg Hausleiter and Kaufman, {Philipp A.} and Kim, {Yong Jin} and Erica Maffei and Hugo Marques and {De Ara{\'u}jo Goncalves}, Pedro and Gianluca Pontone and Raff, {Gilbert L.} and Ronen Rubinshtein and Shaw, {Leslee J.} and Villines, {Todd C.} and Heidi Gransar and Yao Lu and Jones, {Erica C.} and Pen{\~a}, {Jessica M.} and Lin, {Fay Y.} and Leonard Kritharides and Min, {James K.}",

year = "2019",

month = nov,

day = "1",

doi = "10.1093/ehjci/jez067",

language = "English",

volume = "20",

pages = "1279--1286",

journal = "European Heart Journal Cardiovascular Imaging",

issn = "2047-2404",

publisher = "Oxford University Press",

number = "11",

}

Gnanenthiran, SR, Naoum, C, Leipsic, JA, Achenbach, S, Al-Mallah, MH, Andreini, D, Bax, JJ, Berman, DS, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Chinnaiyan, K, Chow, BJW, Cury, RC, Delago, A, Feuchtner, G, Hadamitzky, M, Hausleiter, J, Kaufman, PA, Kim, YJ, Maffei, E, Marques, H, De Araújo Goncalves, P, Pontone, G, Raff, GL, Rubinshtein, R, Shaw, LJ, Villines, TC, Gransar, H, Lu, Y, Jones, EC, Penã, JM, Lin, FY, Kritharides, L & Min, JK 2019, 'Long-term prognostic utility of computed tomography coronary angiography in older populations', European Heart Journal Cardiovascular Imaging, vol. 20, no. 11, pp. 1279-1286. https://doi.org/10.1093/ehjci/jez067

TY - JOUR

T1 - Long-term prognostic utility of computed tomography coronary angiography in older populations

AU - Gnanenthiran, Sonali R.

AU - Naoum, Christopher

AU - Leipsic, Jonathon A.

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz H.

AU - Andreini, Daniele

AU - Bax, Jeroen J.

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo C.

AU - Delago, Augustin

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufman, Philipp A.

AU - Kim, Yong Jin

AU - Maffei, Erica

AU - Marques, Hugo

AU - De Araújo Goncalves, Pedro

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Rubinshtein, Ronen

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Gransar, Heidi

AU - Lu, Yao

AU - Jones, Erica C.

AU - Penã, Jessica M.

AU - Lin, Fay Y.

AU - Kritharides, Leonard

AU - Min, James K.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Aims: The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations. Methods and results: From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: None, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): Number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD. Conclusion: The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.

AB - Aims: The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations. Methods and results: From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: None, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): Number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD. Conclusion: The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.

KW - age

KW - coronary computed tomography angiography

KW - major adverse cardiovascular events

KW - mortality

KW - older populations

UR - http://www.scopus.com/inward/record.url?scp=85072193787&partnerID=8YFLogxK

U2 - 10.1093/ehjci/jez067

DO - 10.1093/ehjci/jez067

M3 - Article

C2 - 30993334

AN - SCOPUS:85072193787

SN - 2047-2404

VL - 20

SP - 1279

EP - 1286

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 11

ER -

Long-term prognostic utility of computed tomography coronary angiography in older populations

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