Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events
Related Experiment Video
Updated: Mar 6, 2026

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Christopher Naoum1, Daniel S Berman1, Amir Ahmadi1
1From 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.).
Insights
New nomograms for coronary artery disease (CAD) burden, using coronary computed tomography angiography, predict major adverse cardiovascular events (MACE). These age- and sex-specific tools improve risk assessment beyond traditional methods for better patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery disease (CAD) burden on coronary computed tomography angiography (CCTA) predicts major adverse cardiovascular event (MACE) risk.
- Clinical decision-making is limited by a lack of nomographic data for CAD burden.
- Development of age- and sex-specific nomograms for CAD burden using CCTA is needed.
Purpose of the Study:
- To develop clinically pragmatic age- and sex-specific nomograms of CAD burden using CCTA.
- To validate the prognostic utility of these nomograms in predicting MACE.
- To assess the independence of SIS% in predicting cardiac events.
Main Methods:
- Developed CAD nomograms using age-sex percentiles of segment involvement score (SIS) from 21,132 patients in the CONFIRM registry (Phase I).
- Validated prognostic use in a separate cohort (Phase II, n=3030) by stratifying patients into SIS percentile groups (≤50th, 51-75th, >75th).
- Compared annualized MACE rates and time to MACE using multivariable Cox models, adjusting for Framingham risk and chest pain typicality.
Main Results:
- Age-sex percentiles of SIS showed good fit to polynomial curves (R²=0.86±0.12 for men, R²=0.86±0.14 for women).
- Annualized MACE rates increased significantly with higher SIS% groups (2.1% in ≤50th, 3.9% in 51-75th, 7.2% in >75th; P<0.001).
- Adjusted MACE risk was significantly higher in SIS% groups above the median (HR 1.9 for 51-75th, HR 3.4 for >75th; P<0.01).
Conclusions:
- Clinically pragmatic age- and sex-specific nomograms for CAD prevalence using CCTA findings have been developed.
- Global plaque burden measured by SIS% predicts cardiac events independently of traditional risk assessment.
- These nomograms can enhance clinical decision-making for MACE risk stratification.
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.
More Related Videos
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
06:57Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Related Concept Videos
Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
Coronary Artery Disease I: Introduction
Coronary Artery Disease IV: Preventive Measures
Imaging Studies for Cardiovascular System V: CT
Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
Coronary Artery Disease III: Clinical Manifestations