Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101479935 Publication Model: Print Cited Medium: Internet ISSN: 1942-0080 (Electronic) Linking ISSN: 19419651 NLM ISO Abbreviation: Circ Cardiovasc Imaging Subsets: MEDLINE
    • Publication Information:
      Original Publication: Hagerstown, MD Lippincott Williams & Wilkins
    • Subject Terms:
      Computed Tomography Angiography* ; Multidetector Computed Tomography* ; Nomograms* ; Plaque, Atherosclerotic*; Coronary Angiography/*methods ; Coronary Artery Disease/*diagnostic imaging ; Coronary Vessels/*diagnostic imaging; Adult ; Age Factors ; Aged ; Canada/epidemiology ; Coronary Artery Disease/epidemiology ; Europe/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Registries ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index ; Sex Factors ; United States/epidemiology
    • 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.
      (© 2017 American Heart Association, Inc.)
    • Comments:
      Comment in: Circ Cardiovasc Imaging. 2017 Mar;10(3):. (PMID: 28292864)
    • Contributed Indexing:
      Keywords: computed tomography angiography; coronary angiography; coronary artery disease; epidemiology; nomograms
    • Molecular Sequence:
      ClinicalTrials.gov NCT01443637
    • Publication Date:
      Date Created: 20170316 Date Completed: 20170509 Latest Revision: 20191210
    • Publication Date:
      20231215
    • Accession Number:
      10.1161/CIRCIMAGING.116.004896
    • Accession Number:
      28292858