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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Long-term prognostic utility of computed tomography coronary angiography in older populations
Sonali R Gnanenthiran1, Christopher Naoum1, Jonathon A Leipsic2
1Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
Insights
Coronary computed tomography angiography (CCTA) effectively predicts long-term mortality and major adverse cardiovascular outcomes in both younger and elderly patients. The extent of coronary artery disease (CAD) identified by CCTA is a significant prognostic indicator across all age groups.
Area of Science:
- Cardiology
- Radiology
- Geriatric Medicine
Background:
- The prognostic value of coronary computed tomography angiography (CCTA) for long-term outcomes in elderly patients (≥70 years) remains under-evaluated.
- Assessing the predictive capability of CCTA in older populations is crucial for personalized risk stratification.
Purpose of the Study:
- To compare the 5-year mortality prediction of CCTA-identified coronary artery disease (CAD) in patients aged ≥70 years versus those younger than 70 years.
- To evaluate the prognostic significance of CAD severity and plaque burden in elderly individuals.
Main Methods:
- Analysis of data from the prospective CONFIRM registry, including 7198 patients <70 years and 1786 patients ≥70 years.
- Classification of CAD severity by maximal stenosis degree (none, non-obstructive, obstructive) and segment involvement score (SIS).
- Use of Cox-proportional hazard models to assess the relationship between CCTA findings and mortality over a mean 5.6-year follow-up.
Main Results:
- CCTA-identified CAD significantly predicted increased 5-year mortality in both age groups compared to patients with normal CCTA.
- Both non-obstructive and obstructive CAD, as well as higher SIS, were associated with increased mortality in patients ≥70 years.
- CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) in both younger and older patient cohorts.
Conclusions:
- The presence and extent of CAD, as identified by CCTA, are meaningful stratifiers of long-term mortality and MACE in both elderly and younger populations.
- Obstructive and non-obstructive CAD, along with the plaque burden quantified by SIS, are important prognostic predictors in older adults.
Aims:
The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations.
Methods And Results:
From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: none, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD.
Conclusion:
The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.
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