Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events

被引：32

作者：

Naoum, Christopher ^{[1
]}

Berman, Daniel S. ^{[2
]}

Ahmadi, Amir ^{[3
]}

Blanke, Philipp ^{[1
]}

Gransar, Heidi ^{[2
]}

Narula, Jagat ^{[3
]}

Shaw, Leslee J. ^{[4
]}

Kritharides, Leonard ^{[5
,6
]}

Achenbach, Stephan ^{[7
]}

Al-Mallah, Mouaz H. ^{[8
]}

Andreini, Daniele ^{[9
]}

Budoff, Matthew J. ^{[10
]}

Cademartiri, Filippo ^{[11
,12
]}

Callister, Tracy Q. ^{[13
]}

Chang, Hyuk-Jae ^{[14
,15
]}

Chinnaiyan, Kavitha ^{[16
]}

Chow, Benjamin ^{[17
]}

Cury, Ricardo C. ^{[18
]}

DeLago, Augustin ^{[19
]}

Dunning, Allison ^{[20
]}

Feuchtner, Gudrun ^{[21
]}

Hadamitzky, Martin ^{[22
]}

Hausleiter, Joerg ^{[22
]}

Kaufmann, Philipp A. ^{[23
]}

Kim, Yong-Jin ^{[24
]}

Maffei, Erica ^{[11
,12
]}

Marquez, Hugo ^{[25
]}

Pontone, Gianluca ^{[9
]}

Raff, Gilbert ^{[16
]}

Rubinshtein, Ronen ^{[26
]}

Villines, Todd C. ^{[27
,28
]}

Min, James ^{[29
,30
]}

Leipsic, Jonathon ^{[1
]}

机构：

[1] Univ British Columbia, Dept Med & Radiol, Vancouver, BC, Canada

[2] Cedars Sinai Med Ctr, Dept Imaging, Los Angeles, CA 90048 USA

[3] Mt Sinai Hosp Med Ctr, Dept Cardiol, New York, NY USA

[4] Emory Univ, Sch Med, Div Cardiol, Atlanta, GA 30322 USA

[5] Concord Hosp, Dept Cardiol, Sydney, NSW, Australia

[6] Univ Sydney, Sydney, NSW, Australia

[7] Univ Erlangen Nurnberg, Dept Med, Erlangen, Germany

[8] Wayne State Univ, Henry Ford Hosp, Dept Med, Detroit, MI USA

[9] Univ Milan, IRCCS, Ctr Cardiol Monzino, Dept Clin Sci & Community Hlth, Milan, Italy

[10] Harbor Univ Calif Los Angeles Med Ctr, Dept Med, Torrance, CA USA

[11] Giovanni XXIII Hosp, Cardiovasc Imaging Unit, Treviso, Italy

[12] Erasmus MC, Dept Radiol, Rotterdam, Netherlands

[13] Tennessee Heart & Vasc Inst, Hendersonville, NC USA

[14] Yonsei Univ Hlth Syst, Yonsei Univ, Coll Med, Div Cardiol,Severance Cardiovasc Hosp, Seoul, South Korea

[15] Yonsei Univ Hlth Syst, Yonsei Univ, Coll Med, Severance Biomed Sci Inst, Seoul, South Korea

[16] William Beaumont Hosp, Royal Oak, MI 48072 USA

[17] Univ Ottawa, Dept Med & Radiol, Ottawa, ON, Canada

[18] Baptist Cardiac & Vasc Inst, Miami, FL USA

[19] Capitol Cardiol Associates, Albany, NY USA

[20] Duke Clin Res Inst, Durham, NC USA

[21] Med Univ Innsbruck, Dept Radiol, Innsbruck, Austria

[22] Deutsch Herzzentrum Munich, Div Cardiol, Munich, Germany

[23] Univ Hosp, Dept Nucl Med, Zurich, Switzerland

[24] Seoul Natl Univ Hosp, Seoul, South Korea

[25] Curry Cabral Hosp, Dept Surg, Lisbon, Portugal

[26] Technion Israel Inst Technol, Ruth & Bruce Rappaport Sch Med, Lady Davis Carmel Med Ctr, Dept Cardiol, Haifa, Israel

[27] Walter Reed Med Ctr, Dept Med, Washington, DC USA

[28] Walter Reed Med Ctr, Dept Med, New York, NY USA

[29] New York Presbyterian Hosp, Dept Radiol, New York, NY USA

[30] Weill Cornell Med Coll, New York, NY USA

来源：

CIRCULATION-CARDIOVASCULAR IMAGING | 2017年 / 10卷 / 03期

基金：

美国国家卫生研究院;

关键词：

computed tomography angiography; coronary artery disease; coronary angiography; epidemiology; nomograms; ARTERY-DISEASE; PROGNOSTIC VALUE; INTERNATIONAL MULTICENTER; CARDIOVASCULAR RISK; MORTALITY INCIDENCE; CT ANGIOGRAPHY; CALCIUM;

D O I：

10.1161/CIRCIMAGING.116.004896

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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: R-2=0.86 +/- 0.12; women: R-2=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.

引用

页数：11

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