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Chow BJ, Small G, Yam Y, Chen L, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, Chinnaiyan KM, Delago A, Dunning A, Hadamitzky M, Hausleiter J, Kaufmann P, Lin F, Maffei E, Raff GL, Shaw LJ, Villines TC, Min JK. Incremental Prognostic Value of Cardiac Computed Tomography in Coronary Artery Disease Using CONFIRM. Circ Cardiovasc Imaging 2011; 4:463-72. [DOI: 10.1161/circimaging.111.964155] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background—
Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables.
Methods and Results—
A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non–high-risk, or high-risk CAD) and LVEF <50%. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3%) patients (mean follow-up of 22.5 months; 95% confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65% of patients without coronary atherosclerosis, 1.99% of patients with nonobstructive CAD, 2.90% of patients with non–high-risk CAD, and 4.95% for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50% (hazard ratio, 2.74; 95% confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95% confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables.
Conclusions—
Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.
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Affiliation(s)
- Benjamin J.W. Chow
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Gary Small
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Yeung Yam
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Li Chen
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Stephan Achenbach
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Mouaz Al-Mallah
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Daniel S. Berman
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Matthew J. Budoff
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Filippo Cademartiri
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Tracy Q. Callister
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Hyuk-Jae Chang
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Victor Cheng
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Kavitha M. Chinnaiyan
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Augustin Delago
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Allison Dunning
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Martin Hadamitzky
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Jörg Hausleiter
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Philipp Kaufmann
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Fay Lin
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Erica Maffei
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Gilbert L. Raff
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Leslee J. Shaw
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - Todd C. Villines
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
| | - James K. Min
- From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C.); the Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); the Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.A.-M.); the Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.C.); the Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J.B.); the Department of Radiology,
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