Coronary Computed Tomographic Angiography and Risk of All-Cause Mortality and Non-fatal Myocardial Infarction in Subjects without Chest Pain Syndrome from the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry)
Background—The predictive value of coronary computed tomographic angiography (cCTA) in subjects without chest pain syndrome (CPS) has not been established. We investigated the prognostic value of coronary artery disease (CAD) detection by cCTA, and determined the incremental risk stratification benefit of cCTA findings as compared to clinical risk factor scoring and coronary artery calcium scoring (CACS) for individuals without CPS.
Methods and Results—An open-label, 12-center, 6-country observational registry of 27,125 consecutive patients undergoing cCTA and CACS was queried, and 7,590 individuals without CPS or history of CAD met the inclusion criteria. All-cause mortality and composite of all-cause mortality and non-fatal MI were measured. During a median follow-up of 24 months (interquartile range: 18 to 35), all-cause mortality occurred in 136 individuals. After risk adjustment, compared to individuals without evidence of CAD by cCTA, individuals with obstructive 2-VD and 3-VD or left main CAD experienced higher rates of death and composite outcome (P<0.05 for both). Both CACS and cCTA significantly improved the performance of standard risk factor prediction models for all-cause mortality and the composite outcome (likelihood ratio P-value <0.05 for all), but the incremental discriminatory value associated with their inclusion was more pronounced for the composite outcome and for CACS (C statistic for model with risk factors only 0.71, risk factors plus CACS 0.75, risk factors plus CACS plus cCTA 0.77). The net reclassification improvement resulting from the addition of cCTA to a model based on standard risk factors and CACS was negligible.
Conclusions—While prognosis for individuals without CPS is stratified by cCTA, the additional risk-predictive advantage by cCTA is not clinically meaningful compared to risk model based upon CACS. Therefore, at present, the application of cCTA for risk assessment of individuals without CPS should not be justified.
- Received November 21, 2011.
- Accepted May 9, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited