Sonali R Gnanenthiran1, Christopher Naoum1, Jonathon A Leipsic2, Stephan Achenbach3, Mouaz H Al-Mallah4, Daniele Andreini5, Jeroen J Bax6, Daniel S Berman7, Matthew J Budoff8, Filippo Cademartiri9, Tracy Q Callister10, Hyuk-Jae Chang11, Kavitha Chinnaiyan12, Benjamin J W Chow13, Ricardo C Cury14, Augustin DeLago15, Gudrun Feuchtner16, Martin Hadamitzky17, Joerg Hausleiter18, Philipp A Kaufman19, Yong-Jin Kim20, Erica Maffei21, Hugo Marques22, Pedro de Araújo Gonçalves22, Gianluca Pontone5, Gilbert L Raff12, Ronen Rubinshtein23, Leslee J Shaw24, Todd C Villines25, Heidi Gransar26, Yao Lu27, Erica C Jones24, Jessica M Peña24, Fay Y Lin24, Leonard Kritharides1, James K Min24. 1. Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia. 2. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada. 3. Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Germany. 4. King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia. 5. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy. 6. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. 8. Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA. 9. Cardiovascular Imaging Center, SDN IRCCS, Naples, 113, Italy. 10. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA. 11. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. 12. Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA. 13. Department of Medicine and Radiology, University of Ottawa, ON, Canada. 14. Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA. 15. Capitol Cardiology Associates, Albany, NY, USA. 16. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 17. Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. 18. Medizinische Klinik I der Ludwig-Maximilians-UniversitätMönchen, Munich, Germany. 19. Department of Nuclear Medicine, University Hospital, Zurich, Switzerland and University of Zurich, 8091, Switzerland. 20. Seoul National University Hospital, Seoul, South Korea. 21. Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. 22. UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, 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 Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA. 25. Cardiology Service, Walter Reed National Military Center, Bethesda, Maryland, United States of America. 26. Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA. 27. Department of Healthcare Policy and Research, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Daniel E Forman; James A de Lemos; Leslee J Shaw; David B Reuben; Radmila Lyubarova; Eric D Peterson; John A Spertus; Susan Zieman; Marcel E Salive; Michael W Rich Journal: J Am Coll Cardiol Date: 2020-09-29 Impact factor: 24.094
Authors: Sun Joon Moon; Eun Ju Chun; Yeonyee E Yoon; Kyong Soo Park; Hak Chul Jang; Soo Lim Journal: J Am Heart Assoc Date: 2019-11-22 Impact factor: 5.501