24.05.2018 | Original Article
Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age
verfasst von:
Chadi Ayoub, Leonard Kritharides, Yeung Yam, Li Chen, Alomgir Hossain, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk-Jae Chang, Kavitha Chinnaiyan, Ricardo C. Cury, Augustin Delago, Allison Dunning, Gudrun Feuchtner, Millie Gomez, Heidi Gransar, Martin Hadamitzky, Joerg Hausleiter, Niree Hindoyan, Philipp A. Kaufmann, Yong-Jin Kim, Jonathon Leipsic, Erica Maffei, Hugo Marques, Gianluca Pontone, Gilbert Raff, Ronen Rubinshtein, Leslee J. Shaw, Todd C. Villines, James K. Min, Benjamin J. W. Chow
Erschienen in:
Heart and Vessels
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Ausgabe 11/2018
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Abstract
Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of ‘age adjusted SIS’ (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7 years, 55.8% male) with a median follow-up of 27.3 months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83–3.16, p < 0.001), C-statistic 0.723 (0.700–0.756), net reclassification improvement (NRI) 0.36 (0.26–0.47, p < 0.001), and relative integrated discrimination improvement (IDI) 0.33 (p = 0.009). aSIS had HR 3.48 (2.33–5.18, p < 0.001) for mortality in those without obstructive CAD, compared to HR 1.79 (1.25–2.58, p = 0.02) in those with obstructive CAD. In conclusion, aSIS has an incremental prognostic value to traditional risk factors and obstructive CAD, and may enhance CCTA risk stratification.