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Eur Heart J Cardiovasc Imaging. 2018 Jun 1;19(6):675-683. doi: 10.1093/ehjci/jex150.

Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals.

Author information

1
Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 E. 69th Street, Suite 108, New York, NY 10021, USA.
2
Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
3
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.
4
Division of Cardiology, Albany Medical Center, Albany, NY, USA.
5
Duke Clinical Research Institute, Durham, NC, USA.
6
Department of Medicine, University of Erlangen, Erlangen, Germany.
7
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.
8
Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.
9
Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy; Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands.
10
Department of Radiology, ASUR Marche, Area Vasta 1, Ospedale di Urbino, Italy.
11
Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
12
William Beaumont Hospital, Royal Oaks, MI, USA.
13
Department of Medicine and Radiology, University of Ottawa, ON, Canada.
14
Capitol Cardiology Associates, Albany, NY, USA.
15
Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
16
Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
17
University Hospital, Zurich, Switzerland.
18
Emory University School of Medicine, Atlanta, GA, USA.
19
Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.
20
Seoul National University Hospital, Seoul, South Korea.
21
Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
22
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
23
Baptist Cardiac and Vascular Institute, Miami, FL, USA.
24
Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy.
25
UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal.
26
Department of Cardiology, Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Abstract

Aims:

Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults.

Methods and results:

Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles.

Conclusion:

CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.

PMID:
28977374
PMCID:
PMC5963306
DOI:
10.1093/ehjci/jex150
[Indexed for MEDLINE]
Free PMC Article

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