Abstract 14099: Prognostic Value of Coronary CT Angiography for the Prediction of Mortality and Non-Fatal Major Adverse Cardiac Events: Results from the Multinational CONFIRM Registry
Background: The relationship between coronary CT angiography (CTA) findings and mortality is well documented, but data linking measures of atherosclerosis in coronary CTA to major adverse cardiac events (MACE) are limited to small single center studies, and older-generation CT hardware.
Methods: Within the multinational CONFIRM registry, we evaluated 15,223 consecutive patients (57±12 years; 55% male) without known CAD at 8 centers who underwent 64-detector row coronary CTA and had complete follow up of MACE [death, non-fatal myocardial infarction (MI), acute coronary syndrome (ACS) and late coronary revascularization (REV, either by PCI or bypass surgery > 90 days following coronary CTA)] over a mean follow-up of 2.3±1.2 years. MACE were correlated to the presence of any coronary plaque in the baseline CTA as well as to presence of obstructive lesions in increasing numbers of major coronary vessels.
Results: Overall, 1354 (8.9%) patients experienced MACE (185 deaths, 245 MI/ACS, and 1103 REV). Annualized MACE risk for patients with no CAD was low (0.5%). In comparison, MACE risk was significantly increased for non-obstructive CAD [Hazard Ratio (HR) 4.02, (95% CI 3.11-5.20), p<0.0001] as well as obstructive 1-vessel [HR=29.3 (23.1-37.0), p<0.0001], 2-vessel [HR=48.6 (38.0-62.2), p<0.0001], and 3 vessel/left main CAD [HR=61.4 (47.9-78.7), p<0.0001]. In multivariate Cox regression, presence of non-obstructive CAD [HR=3.61, (2.76-4.72), p<0.0001] and obstructive 1-vessel [HR=24.7 (19.2-31.7), p<0.0001], 2-vessel [HR = 38.8 (29.7-50.6), p<0.0001], and 3 vessel/Left Main CAD [HR = 47.7 (36.3-62.6), p<0.0001] resulted in significantly increased risk of MACE when compared to those with no CAD, independent of CAD risk factors. For non-obstructive CAD (n = 5395) in comparison to no CAD (n=7028), HR for ACS/MI was 3.30 (2.10-5.18, p<0.0001) and for REV was 7.86 (5.02-12.3, p<0.0001). For any obstructive CAD (n=2800), HR for ACS/MI was 15.13 (10.1-22.7, p<0.0001) and for REV was 125.0 (82.6-189.0, p<0.0001).
Conclusions: During a 2.3 year follow-up of 15,223 patients undergoing coronary CTA, measures both of non-obstructive and obstructive CAD stratified individuals at increased risk of MACE, including revascularization and non-fatal infarction.
- © 2011 by American Heart Association, Inc.