Long-term prognostic utility of computed tomography coronary angiography in older populations

Gnanenthiran, S.R.; Naoum, C.; Leipsic, J.A.; Achenbach, S.; Al-Mallah, M.H.; Andreini, D.; Bax, J.J.; Berman, D.S.; Budoff, M.J.; Cademartiri, F.; Callister, T.Q.; Chang, H.J.; Chinnaiyan, K.; Chow, B.J.W.; Cury, R.C.; DeLago, A.; Feuchtner, G.; Hadamitzky, M.; Hausleiter, J.; Kaufman, P.A.; Kim, Y.J.; Maffei, E.; Marques, H.; Goncalves, P.D.; Pontone, G.; Raff, G.L.; Rubinshtein, R.; Shaw, L.J.; Villines, T.C.; Gransar, H.; Lu, Y.; Jones, E.C.; Pena, J.M.; Lin, F.Y.; Kritharides, L.; Min, J.K.

doi:doi:10.1093/ehjci/jez067

Aims The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (>= 70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations.Methods and results From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. >= 70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: none, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 +/- 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non...Show moreAims The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (>= 70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations.Methods and results From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. >= 70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: none, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 +/- 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and >= 70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS >= 4: 2.42 (1.65-3.57), P < 0.001] and >= 70 years [SIS 1-3: 1.73 (1.07-2.79); SIS >= 4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD.Conclusion The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and >= 70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.Show less

Leiden University Scholarly Publications

View statistics

In Collections

Long-term prognostic utility of computed tomography coronary angiography in older populations