Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events

Christopher Naoum; Daniel S Berman; Amir Ahmadi; Philipp Blanke; Heidi Gransar; Jagat Narula; Leslee J Shaw; Leonard Kritharides; Stephan Achenbach; Mouaz H Al-Mallah; Daniele Andreini; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin Chow; Ricardo C Cury; Augustin DeLago; Allison Dunning; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A Kaufmann; Yong-Jin Kim; Erica Maffei; Hugo Marquez; Gianluca Pontone; Gilbert Raff; Ronen Rubinshtein; Todd C Villines; James Min; Jonathon Leipsic

doi:10.1161/CIRCIMAGING.116.004896

Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events

Circ Cardiovasc Imaging. 2017 Mar;10(3):e004896. doi: 10.1161/CIRCIMAGING.116.004896.

Authors

Christopher Naoum¹, Daniel S Berman¹, Amir Ahmadi¹, Philipp Blanke¹, Heidi Gransar¹, Jagat Narula¹, Leslee J Shaw¹, Leonard Kritharides¹, Stephan Achenbach¹, Mouaz H Al-Mallah¹, Daniele Andreini¹, Matthew J Budoff¹, Filippo Cademartiri¹, Tracy Q Callister¹, Hyuk-Jae Chang¹, Kavitha Chinnaiyan¹, Benjamin Chow¹, Ricardo C Cury¹, Augustin DeLago¹, Allison Dunning¹, Gudrun Feuchtner¹, Martin Hadamitzky¹, Joerg Hausleiter¹, Philipp A Kaufmann¹, Yong-Jin Kim¹, Erica Maffei¹, Hugo Marquez¹, Gianluca Pontone¹, Gilbert Raff¹, Ronen Rubinshtein¹, Todd C Villines¹, James Min¹, Jonathon Leipsic²

Affiliations

¹ From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.).
² From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.). jleipsic@providencehealth.bc.ca.

PMID: 28292858
DOI: 10.1161/CIRCIMAGING.116.004896

Abstract

Background: Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use.

Methods and results: Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R²=0.86±0.12; women: R²=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both).

Conclusions: We have developed clinically pragmatic age- and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01443637.

Keywords: computed tomography angiography; coronary angiography; coronary artery disease; epidemiology; nomograms.

Publication types

Multicenter Study
Validation Study

MeSH terms

Adult
Age Factors
Aged
Canada / epidemiology
Computed Tomography Angiography*
Coronary Angiography / methods*
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / epidemiology
Coronary Vessels / diagnostic imaging*
Europe / epidemiology
Female
Humans
Male
Middle Aged
Multidetector Computed Tomography*
Nomograms*
Plaque, Atherosclerotic*
Predictive Value of Tests
Prevalence
Prognosis
Prospective Studies
Registries
Reproducibility of Results
Republic of Korea / epidemiology
Risk Factors
Severity of Illness Index
Sex Factors
United States / epidemiology

Associated data

ClinicalTrials.gov/NCT01443637