Coronary artery disease
Usefulness of Coronary Computed Tomography Angiography to Predict Mortality and Myocardial Infarction Among Caucasian, African and East Asian Ethnicities (from the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter] Registry)

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Studies examining coronary computed tomographic angiography (CCTA) have demonstrated increased mortality related to coronary artery disease (CAD) severity but are limited to relatively nondiverse ethnic populations. The aim of this study was to evaluate the prognostic significance of CAD on CCTA according to ethnicity for patients without previous CAD in a prospective international CCTA registry of 11 sites (7 countries) who underwent 64-slice CCTA from 2005 to 2010. CAD was defined as any coronary artery atherosclerosis and obstructive CAD as ≥50% stenosis. All-cause mortality and nonfatal myocardial infarction (MI) were assessed by ethnicity using Kaplan-Meier and Cox proportional hazards, controlling for baseline risk factors, medications, and revascularization. A total of 16,451 patients of mean age 58 years (55% men) were followed over a median of 2.0 years (interquartile range 1.4 to 3.2). Patients were 60.1% Caucasian, 34.4% East Asian, and 5.5% African. Death or MI occurred in 0.5% (38 of 7,109) among patients with no CAD, 1.6% (91 of 5,600) among those with nonobstructive CAD, and 3.8% (142 of 3,742) among those with ≥50% stenosis (p <0.001 among all groups). The annualized incidence of death or MI comparing obstructive to no obstructive CAD among Caucasians was 2.2% versus 0.7% (adjusted hazard ratio [aHR] 2.77, 95% confidence interval [CI] 1.73 to 4.43, p <0.001), among Africans 4.8% versus 1.1% (aHR 6.25, 95% CI 1.12 to 34.97, p = 0.037), and among East Asians 0.8% versus 0.1% (aHR 4.84, 95% CI 2.24 to 10.9, p <0.001). Compared to other ethnicities, East Asians had fewer than expected events (aHR 0.25, 95% CI 0.16 to 0.38, p <0.001). In conclusion, the presence and severity of CAD visualized by CCTA predict death or MI across 3 large ethnicities, whereas normal results on CCTA identify patients at very low risk.

Section snippets

Methods

The Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter (CONFIRM) registry is an ongoing, prospective, international, multicenter registry designed to evaluate the relation of coronary atherosclerosis and clinical risk factors to adverse outcomes among patients who have undergone at least 64-slice CCTA for clinically referred indications (ClinicalTrials.gov identifier NCT01443637).10 The rationale and design of the CONFIRM registry have been previously

Results

Ethnicity data were coded for 16,451 patients at 11 sites (7 countries). The mean age was 58 ± 12 years (55% men), and patients were followed over a median of 2.0 years (interquartile range 1.4 to 3.2 years). Middle Eastern (n = 67), South Asian (n = 72), Hispanic (n = 534), and other (n = 127) ethnicities were each coded during data collection but were excluded because they were individually underpowered for analysis. Baseline demographics are listed in Table 1. Patients were 60.1% Caucasian,

Discussion

CCTA has emerged as an important diagnostic test for the assessment of CAD with increasingly proved prognostic value, but studies published to date contain minimal information regarding the prognostic value of CCTA among different ethnic subgroups.1, 3, 4, 17, 18, 19, 20 Studies using noncontrast computed tomography to detect and quantify calcified atherosclerosis have demonstrated ethnic variations in calcified CAD prevalence and have confirmed the prognostic value of calcium scoring in

Disclosures

Dr. Villines has received speaker's honoraria from Boehringer-Ingelheim, Ingelheim, Germany. Dr. Achenbach has received grant support from Siemens Healthcare, Erlangen, Germany, and Bayer Schering Pharma AG, Berlin, Germany. Dr. Budoff has received speaker's honoraria from GE Healthcare, Milwaukee, Wisconsin. Dr. Cademartiri has received grant support from GE Healthcare and speaker's honoraria from Bracco Diagnostics, Milan, Italy. Dr. Callister is on the speaker's bureau of GE Healthcare. Dr.

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