Age- and Sex-Related Differences in All-Cause Mortality Risk Based on Coronary Computed Tomography Angiography Findings: Results From the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 Patients Without Known Coronary Artery Disease

We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have n...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2011-08, Vol.58 (8), p.849-860
Main Authors: MIN, James K, DUNNING, Allison, CHINNAIYAN, Kavitha, CHOW, Benjamin J. W, DELAGO, Augustin, HADAMITZKY, Martin, HAUSLEITER, Joerg, KAUFMANN, Philipp, MAFFEI, Erica, RAFF, Gilbert, SHAW, Leslee J, VILLINES, Todd, LIN, Fay Y, BERMAN, Daniel S, ACHENBACH, Stephan, AL-MALLAH, Mouaz, BUDOFF, Matthew J, CADEMARTIRI, Filippo, CALLISTER, Tracy Q, CHANG, Hyuk-Jae, CHENG, Victor
Format: Article
Language:English
Subjects:
Age
Age Factors
Aged
Angiography
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular disease
Cardiovascular system
Computed tomography
Coronary Angiography
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - mortality
Coronary heart disease
Coronary Stenosis - diagnostic imaging
Coronary Stenosis - mortality
Coronary vessels
Diabetes
Dose-response effects
Drug therapy
Female
Follow-Up Studies
Heart
Heart attacks
Heart diseases
Heart rate
Humans
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical imaging
Medical sciences
Middle Aged
Mortality
Pain
Patients
Prognosis
Proportional Hazards Models
Prospective Studies
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Registries
Risk Assessment
Severity of Illness Index
Sex
Sex differences
Sex Factors
Stenosis
Tomography, X-Ray Computed
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Summary:We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes. We evaluated a consecutive cohort of 24,775 patients undergoing ≥64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (≥70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models. At a 2.3 ± 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2011.02.074