The long-term prognostic benefit of coronary computed tomographic angiography (CCTA) findings of coronary artery disease (CAD) in asymptomatic populations is still unknown. From the prospective multicentre international CONFIRM long-term study, thre Authors of this paper evaluated asymptomatic subjects without known CAD who underwent both coronary artery calcium scoring (CACS) and CCTA (n = 1,226).
Using the C-statistic and likelihood ratio tests, they evaluated the incremental prognostic utility of CCTA findings over a base model that included a panel of traditional risk factors (RFs) as well as CACS to predict long-term all-cause mortality. Compared with the traditional RF alone, CCTA findings including coronary stenosis severity, plaque composition, and coronary segment location demonstrated improved incremental prognostic utility beyond traditional RF alone. However, no added prognostic benefit was offered by CCTA findings when added to a base model containing both traditional RF and CACS.
Coronary CT angiography, therefore, improved prognostication of 6-year all-cause mortality beyond a set of conventional risk factors alone, but no further incremental value was offered by CCTA when CCTA findings were added to a model incorporating risk factors and coronary artery calcium scoring.
Cho I, Al'Aref SJ, Berger A, Ó Hartaigh B, Gransar H, Valenti V, Lin FY, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, DeLago A, Villines TC, Hadamitzky M, Hausleiter J, Leipsic J, Shaw LJ, Kaufmann PA, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Marques H, Rubinshtein R, Chang HJ, Min JK. Prognostic value of coronary computed tomographic angiography findings in asymptomatic individuals: a 6-year follow-up from the prospective multicentre international CONFIRM study. Eur Heart J 2018 Jan 20. doi: 10.1093/eurheartj/ehx774. [Epub ahead of print] Go to PubMed