Clinical Research
Cardiac Imaging
Optimized Prognostic Score for Coronary Computed Tomographic Angiography: Results From the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry)

https://doi.org/10.1016/j.jacc.2013.04.064Get rights and content
Under an Elsevier user license
open archive

Objectives

The aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with suspected coronary artery disease (CAD).

Background

Coronary computed tomography angiography carries important prognostic information in addition to the detection of obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk predictors.

Methods

The analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was modeled. The endpoint was all-cause mortality.

Results

During a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was the number of proximal segments with mixed or calcified plaques (C-index 0.64, p < 0.0001) and the number of proximal segments with a stenosis >50% (C-index 0.56, p = 0.002). In an optimized score including both parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or a stenosis >50% is equivalent to a 5-year increase in age or the risk of smoking.

Conclusions

In CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.

Key Words

coronary artery disease
coronary CT angiography
prognosis

Abbreviations and Acronyms

CAD
coronary artery disease
CCTA
coronary computed tomography angiography
CI
confidence interval
CT
computed tomography
IQR
interquartile range
NCEP ATP III
National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
NRI
net reclassification improvement

Cited by (0)

Dr. Achenbach has received grant support from Siemens and Bayer Schering Pharma and been consultant to Servier. Dr. Al-Mallah has received support from the American Heart Association, Blue Cross Blue Shield Foundation of Michigan, and Astellas. Dr. Budoff has served on the Speakers' Bureau for GE Healthcare. Dr. Cademartiri has received grant support from GE Healthcare, served on the Speakers' Bureau for Bracco and Siemens, and been a consultant to Guerbet's and Servier. Dr. Callister has served on the Speakers' Bureau for GE Healthcare. Dr. Chinnaiyan has received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care Michigan. Dr. Chow has received research support from GE Healthcare, Pfizer, and AstraZeneca and educational support from TeraRecon. Dr. Kaufmann has received institutional research support from GE Healthcare and grant support from the Swiss National Science Foundation. Dr. Min has served on the medical advisory boards of GE Healthcare, Arineta, Astra Zeneca, and Bristol-Myers Squibb; Speakers' Bureau of GE Healthcare; and received research support from GE Healthcare, Vital Images, and Phillips Healthcare. Dr. Maffei has received grant support from GE Healthcare and has consulted for Astra Zeneca and Bristol-Myers Squibb. Dr. Raff has received grant support from Siemens, Blue Cross Blue Shield Blue Care Michigan, and Bayer Pharma. Dr. Hausleiter has received an unrestricted research grant from Siemens Medical Systems and has received support from Abbot Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.