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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.
SUBMITTER: Han D
PROVIDER: S-EPMC5963306 | biostudies-literature | 2018 Jun
REPOSITORIES: biostudies-literature
Han Donghee D Hartaigh Bríain Ó BÓ Gransar Heidi H Lee Ji Hyun JH Rizvi Asim A Baskaran Lohendran L Schulman-Marcus Joshua J Dunning Allison A Achenbach Stephan S Al-Mallah Mouaz H MH Berman Daniel S DS Budoff Matthew J MJ Cademartiri Filippo F Maffei Erica E Callister Tracy Q TQ Chinnaiyan Kavitha K Chow Benjamin J W BJW DeLago Augustin A Hadamitzky Martin M Hausleiter Joerg J Kaufmann Philipp A PA Raff Gilbert G Shaw Leslee J LJ Villines Todd C TC Kim Yong-Jin YJ Leipsic Jonathon J Feuchtner Gudrun G Cury Ricardo C RC Pontone Gianluca G Andreini Daniele D Marques Hugo H Rubinshtein Ronen R Hindoyan Niree N Jones Erica C EC Gomez Millie M Lin Fay Y FY Chang Hyuk-Jae HJ Min James K JK
European heart journal. Cardiovascular Imaging 20180601 6
<h4>Aims</h4>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.<h4>Methods and results</h4>Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was ...[more]