Simon Deseive1, Leslee J Shaw2, James K Min3, Stephan Achenbach4, Daniele Andreini5, Mouaz H Al-Mallah6, Daniel S Berman7, Matthew J Budoff8, Tracy Q Callister9, Filippo Cademartiri10,11, Hyuk-Jae Chang12, Kavitha Chinnaiyan13, Benjamin J W Chow14, Ricardo C Cury15, Augustin DeLago16, Allison M Dunning17, Gudrun Feuchtner18, Philipp A Kaufmann19, Yong-Jin Kim20, Jonathon Leipsic21, Hugo Marques22, Erica Maffei10,11, Gianluca Pontone5, Gilbert Raff13, Ronin Rubinshtein23, Todd C Villines24, Jörg Hausleiter1, Martin Hadamitzky25. 1. Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany. 2. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. 3. Department of Radiology, New York Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 4. Department of Medicine, University of Erlangen, Erlangen, Germany. 5. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico, Monzino, IRCCS Milan, Milano, Italy. 6. Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA. 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. Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy. 11. Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 12. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. 13. William Beaumont Hospital, Royal Oaks, MI, USA. 14. Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada. 15. Baptist Cardiac and Vascular Institute, Miami, FL, USA. 16. Capitol Cardiology Associates, Albany, NY, USA. 17. Duke Clinical Research Institute, Durham, NC, USA. 18. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 19. University Hospital, Zurich, Switzerland. 20. Seoul National University Hospital, Seoul, South Korea. 21. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada. 22. Hospital da Luz, Lisbon, Portugal. 23. Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel. 24. Department of Medicine, Walter Reed Medical Center, Washington, DC, USA. 25. Division of Radiology, Deutsches Herzzentrum Muenchen, Lazarettstr. 36, Munich 80636, Germany.
Abstract
AIMS: To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS: Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality. The predictive value of the CONFIRM score over clinical risk scores (Morise, Framingham, and NCEP ATP III score) was studied in the entire patient population as well as in subgroups. Improvement in risk prediction and patient reclassification were assessed using categorical net reclassification index (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 5.3 years, 982 (6.5%) of 15 219 patients died. The CONFIRM score outperformed the prognostic value of the studied three clinical risk scores (c-indices: CONFIRM score 0.696, NCEP ATP III score 0.675, Framingham score 0.610, Morise score 0.606; c-index for improvement CONFIRM score vs. NCEP ATP III score 0.650, P < 0.0001). Application of the CONFIRM score allowed reclassification of 34% of patients when compared with the NCEP ATP III score, which was the best clinical risk score. Reclassification was significant as revealed by categorical NRI (0.06 with 95% CI 0.02 and 0.10, P = 0.005) and IDI (0.013 with 95% CI 0.01 and 0.015, P < 0.001). Subgroup analysis revealed a comparable performance in a variety of patient subgroups. CONCLUSIONS: The CONFIRM score permits a significantly improved prediction of mortality over clinical risk scores for >5 years after CCTA. These findings are consistent in a large variety of patient subgroups. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS: Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality. The predictive value of the CONFIRM score over clinical risk scores (Morise, Framingham, and NCEP ATP III score) was studied in the entire patient population as well as in subgroups. Improvement in risk prediction and patient reclassification were assessed using categorical net reclassification index (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 5.3 years, 982 (6.5%) of 15 219 patients died. The CONFIRM score outperformed the prognostic value of the studied three clinical risk scores (c-indices: CONFIRM score 0.696, NCEP ATP III score 0.675, Framingham score 0.610, Morise score 0.606; c-index for improvement CONFIRM score vs. NCEP ATP III score 0.650, P < 0.0001). Application of the CONFIRM score allowed reclassification of 34% of patients when compared with the NCEP ATP III score, which was the best clinical risk score. Reclassification was significant as revealed by categorical NRI (0.06 with 95% CI 0.02 and 0.10, P = 0.005) and IDI (0.013 with 95% CI 0.01 and 0.015, P < 0.001). Subgroup analysis revealed a comparable performance in a variety of patient subgroups. CONCLUSIONS: The CONFIRM score permits a significantly improved prediction of mortality over clinical risk scores for >5 years after CCTA. These findings are consistent in a large variety of patient subgroups. Published on behalf of the European Society of Cardiology. All rights reserved.
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