Iksung Cho1, Hyuk-Jae Chang2, Bríain Ó Hartaigh3, Sanghoon Shin4, Ji Min Sung4, Fay Y Lin5, Stephan Achenbach6, Ran Heo7, Daniel S Berman7, Matthew J Budoff8, Tracy Q Callister9, Mouaz H Al-Mallah10, Filippo Cademartiri11, Kavitha Chinnaiyan12, Benjamin J W Chow13, Allison M Dunning14, Augustin DeLago15, Todd C Villines16, Martin Hadamitzky17, Joerg Hausleiter18, Jonathon Leipsic19, Leslee J Shaw20, Philipp A Kaufmann21, Ricardo C Cury22, Gudrun Feuchtner23, Yong-Jin Kim24, Erica Maffei11, Gilbert Raff12, Gianluca Pontone25, Daniele Andreini25, James K Min3. 1. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 2. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea hjchang@yuhs.ac. 3. Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 4. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno Seodaemungu, Seoul, South Korea. 5. Department of Medicine, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. 6. Department of Medicine, University of Erlangen, Erlangen, Germany. 7. Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA. 8. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA. 9. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA. 10. Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA. 11. Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 12. William Beaumont Hospital, Royal Oaks, MI, USA. 13. Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada. 14. Duke Clinical Research Institute, Durham, NC, USA. 15. Capitol Cardiology Associates, Albany, NY, USA. 16. Department of Medicine, Walter Reed Medical Center, Washington, DC, USA. 17. Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany. 18. Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany. 19. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada. 20. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. 21. University Hospital, Zurich, Switzerland. 22. Baptist Cardiac and Vascular Institute, Miami, FL, USA. 23. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 24. Seoul National University Hospital, Seoul, South Korea. 25. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Abstract
AIM: Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. METHODS AND RESULTS: From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels-as defined by the per-patient presence of a ≥50% luminal stenosis-was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ(2), C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ(2), 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS. CONCLUSION: Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS. Published on behalf of the European Society of Cardiology. All rights reserved.
AIM: Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. METHODS AND RESULTS: From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels-as defined by the per-patient presence of a ≥50% luminal stenosis-was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ(2), C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ(2), 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS. CONCLUSION: Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS. Published on behalf of the European Society of Cardiology. All rights reserved.
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