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Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age.

  • Author(s): Ayoub, C
  • Kritharides, L
  • Yam, Y
  • Chen, L
  • Hossain, A
  • Achenbach, S
  • Al-Mallah, MH
  • Andreini, D
  • Berman, DS
  • Budoff, MJ
  • Cademartiri, F
  • Callister, TQ
  • Chang, H-J
  • Chinnaiyan, K
  • Cury, RC
  • Delago, A
  • Dunning, A
  • Feuchtner, G
  • Gomez, M
  • Gransar, H
  • Hadamitzky, M
  • Hausleiter, J
  • Hindoyan, N
  • Kaufmann, PA
  • Kim, Y-J
  • Leipsic, J
  • Maffei, E
  • Marques, H
  • Pontone, G
  • Raff, G
  • Rubinshtein, R
  • Shaw, LJ
  • Villines, TC
  • Min, JK
  • Chow, BJW
  • et al.
Abstract

Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of 'age adjusted SIS' (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7 years, 55.8% male) with a median follow-up of 27.3 months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83-3.16, p < 0.001), C-statistic 0.723 (0.700-0.756), net reclassification improvement (NRI) 0.36 (0.26-0.47, p < 0.001), and relative integrated discrimination improvement (IDI) 0.33 (p = 0.009). aSIS had HR 3.48 (2.33-5.18, p < 0.001) for mortality in those without obstructive CAD, compared to HR 1.79 (1.25-2.58, p = 0.02) in those with obstructive CAD. In conclusion, aSIS has an incremental prognostic value to traditional risk factors and obstructive CAD, and may enhance CCTA risk stratification.

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