Abstract 12199: What is the Optimal Prognostic Method for Scoring Coronary Artery Disease on a CT Angiogram? Results from the Multinational CONFIRM Registry (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter Registry)
Background: Coronary CT angiography (CCTA) is an emerging modality for assessing coronary artery disease (CAD). Besides the detection of obstructive disease, it can detect both nonobstructive calcified and noncalcified plaques. Data how this information can be used for the prediction of all cause mortality is limited.
Methods: We analyzed 13638 consecutive patients from 7 centers in 4 countries. All CCTA were evaluated for lumen narrowing and calcified and noncalcified plaques on a per-segment level. Then the most severe stenosis, the extent of CAD (categorized as normal, nonobstructive, 1 to 3 vessel obstructive), and plaque scores for the proximal and for all coronary segments were calculated. All parameters were corrected for the pre test risk assessed by the Morise clinical risk score. The endpoint of the study was all cause mortality.
Results: During a median follow-up of 2.0 years, 298 patients died. With the exception of the noncalcified plaque score, all parameters correlated strongly with the endpoint (all p<0.001). In a multivariable model the combination of the extent of CAD and the calcified plaque score of proximal segments was the best predictor of all cause mortality showing an annual event rate of 0.3% (95%CI 0.2–0.5%) for the lowest tertile and 2.1% (95%CI 1.8–2.5%) for the highest tertile (Hazard ratio 6.2, 95%CI 4.5–8.6, p<0.001). The incremental predictive value is depicted in the Figure below.
Conclusion: In CCTA, both the extent of obstructive CAD and the calcified plaque burden, particularly in the proximal segments, carry incremental prognostic value over clinical risk predictors.
- © 2010 by American Heart Association, Inc.