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

  • Author(s): Han, Donghee
  • Hartaigh, Bríain Ó
  • Gransar, Heidi
  • Lee, Ji Hyun
  • Rizvi, Asim
  • Baskaran, Lohendran
  • Schulman-Marcus, Joshua
  • Dunning, Allison
  • Achenbach, Stephan
  • Al-Mallah, Mouaz H
  • Berman, Daniel S
  • Budoff, Matthew J
  • Cademartiri, Filippo
  • Maffei, Erica
  • Callister, Tracy Q
  • Chinnaiyan, Kavitha
  • Chow, Benjamin JW
  • DeLago, Augustin
  • Hadamitzky, Martin
  • Hausleiter, Joerg
  • Kaufmann, Philipp A
  • Raff, Gilbert
  • Shaw, Leslee J
  • Villines, Todd C
  • Kim, Yong-Jin
  • Leipsic, Jonathon
  • Feuchtner, Gudrun
  • Cury, Ricardo C
  • Pontone, Gianluca
  • Andreini, Daniele
  • Marques, Hugo
  • Rubinshtein, Ronen
  • Hindoyan, Niree
  • Jones, Erica C
  • Gomez, Millie
  • Lin, Fay Y
  • Chang, Hyuk-Jae
  • Min, James K
  • et al.
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.

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