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Long-term prognostic utility of computed tomography coronary angiography in older populations.

  • Author(s): Gnanenthiran, Sonali R
  • Naoum, Christopher
  • Leipsic, Jonathon A
  • Achenbach, Stephan
  • Al-Mallah, Mouaz H
  • Andreini, Daniele
  • Bax, Jeroen J
  • Berman, Daniel S
  • Budoff, Matthew J
  • Cademartiri, Filippo
  • Callister, Tracy Q
  • Chang, Hyuk-Jae
  • Chinnaiyan, Kavitha
  • Chow, Benjamin JW
  • Cury, Ricardo C
  • DeLago, Augustin
  • Feuchtner, Gudrun
  • Hadamitzky, Martin
  • Hausleiter, Joerg
  • Kaufman, Philipp A
  • Kim, Yong-Jin
  • Maffei, Erica
  • Marques, Hugo
  • de Araújo Gonçalves, Pedro
  • Pontone, Gianluca
  • Raff, Gilbert L
  • Rubinshtein, Ronen
  • Shaw, Leslee J
  • Villines, Todd C
  • Gransar, Heidi
  • Lu, Yao
  • Jones, Erica C
  • Peña, Jessica M
  • Lin, Fay Y
  • Kritharides, Leonard
  • Min, James K
  • et al.
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.

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