Autor(es):
Naoum, C ; Berman, D ; Ahmadi, A ; Blanke, P ; Gransar, H ; Narula, J ; Shaw, LJ ; Kritharides, L ; Achenbach, S ; Al-Mallah, M ; Andreini, D ; Budoff, MJ ; Cademartiri, F ; Callister, TQ ; Chang, HJ ; Chinnaiyan, K ; Chow, B ; Cury, R ; DeLago, A ; Dunning, A ; Feuchtner, G ; Hadamitzky, M ; Hausleiter, J ; Kaufmann, PA ; Kim, YJ ; Maffei, E ; Marquez, H ; Pontone, G ; Raff, G ; Rubinshtein, R ; Villines, TC ; Min, J ; Leipsic, J
Data: 2017
Identificador Persistente: http://hdl.handle.net/10400.17/3642
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): Adult; Age Factors; Aged; Canada; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Europe; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prevalence; Prognosis; Prospective Studies; Registries; Reproducibility of Results; Republic of Korea; Risk Factors; Severity of Illness Index; Sex Factors; United States; Computed Tomography Angiography; Multidetector Computed Tomography; Nomograms; Plaque, Atherosclerotic; HCC CIR
Descrição
Background: Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. Methods and results: Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both). Conclusions: We have developed clinically pragmatic age- and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.
