Abstract 15717: Coronary Artery Disease Burden by Coronary CT Angiography Predicts Mortality and Myocardial Infarction Across Multiple Ethnicities: Results from the CONFIRM Registry
Introduction: Studies examining coronary CT angiography (CCTA) have demonstrated increased mortality and non-fatal myocardial infarction (MI) related to coronary artery disease (CAD) burden, but are limited to relatively non-diverse ethnic populations. The prognostic information derived from CCTA across multiple ethnicities has not been fully explored.
Hypothesis: CAD burden assessed by CCTA predicts risk for future death/MI across multiple ethnic subgroups.
Methods: We evaluated patients without prior CAD from 7 sites (6 countries) within an international CT registry who underwent ≥64-slice CCTA from 2005-2010. CAD was defined by the presence of any coronary artery plaque and obstructive CAD (≥50% diameter stenosis) in increasing numbers of major epicardial vessels. All-cause mortality and MI were assessed by Kaplan Meier and Cox proportional hazards to calculate adjusted hazard ratios (aHR) controlling for conventional risk factors and CAD severity, stratified by ethnicity.
Results: 14,320 patients of mean age 58 years (57% male) were followed over a median of 2.0 years (interquartile range 1.8 years). Patients were 63% Caucasian, 5% African, 0.2% Latin, 30% East Asian, and 1.6% other. Death/MI occurred in 0.6% (38/6521) amongst individuals with no CAD, 1.6% (84/5110) with non-obstructive CAD, 3.3% (55/1669) with 1-vessel, 5.9% (40/682) with 2-vessel and 8.3% (28/338) with 3-vessel CAD. The annualized incidence of death/MI comparing obstructive disease to non among Caucasians was 2.6% vs. 0.7%, aHR of 2.71 (95% CI 2.01-3.68, p<0.001); Africans 4.7% vs. 1.1%, aHR 4.06 (1.38-11.97, p=0.02); and East Asians 0.9% vs. 0.1%, aHR 6.80 (3.14-14.7, p<0.001). Latins and other ethnicities were underpowered. East Asians had lower than expected events compared to other ethnicities, aHR 0.14 (95% CI 0.09-0.21, p<0.001).
Conclusions: While the presence and severity of CAD visualized by CCTA is predictive of all-cause mortality and MI for individuals across multiple ethnicities, significant differences in event rates based upon CAD findings exist by ethnicity with East Asians experiencing the lowest rates of events. Importantly, the absence of CAD identifies patients at very low risk for death/MI across a variety of ethnic groups.
- © 2011 by American Heart Association, Inc.