TY - JOUR
T1 - Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events
AU - Naoum, Christopher
AU - Berman, Daniel S.
AU - Ahmadi, Amir
AU - Blanke, Philipp
AU - Gransar, Heidi
AU - Narula, Jagat
AU - Shaw, Leslee J.
AU - Kritharides, Leonard
AU - Achenbach, Stephan
AU - Al-Mallah, Mouaz H.
AU - Andreini, Daniele
AU - Budoff, Matthew J.
AU - Cademartiri, Filippo
AU - Callister, Tracy Q.
AU - Chang, Hyuk Jae
AU - Chinnaiyan, Kavitha
AU - Chow, Benjamin
AU - Cury, Ricardo C.
AU - DeLago, Augustin
AU - Dunning, Allison
AU - Feuchtner, Gudrun
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Kaufmann, Philipp A.
AU - Kim, Yong Jin
AU - Maffei, Erica
AU - Marquez, Hugo
AU - Pontone, Gianluca
AU - Raff, Gilbert
AU - Rubinshtein, Ronen
AU - Villines, Todd C.
AU - Min, James
AU - Leipsic, Jonathon
N1 - Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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: R2=0.86±0.12; women: R2=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.
AB - 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: R2=0.86±0.12; women: R2=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.
KW - Computed tomography angiography
KW - Coronary angiography
KW - Coronary artery disease
KW - Epidemiology
KW - Nomograms
UR - http://www.scopus.com/inward/record.url?scp=85016204815&partnerID=8YFLogxK
U2 - 10.1161/CIRCIMAGING.116.004896
DO - 10.1161/CIRCIMAGING.116.004896
M3 - Article
C2 - 28292858
AN - SCOPUS:85016204815
SN - 1941-9651
VL - 10
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 3
M1 - e004896
ER -