Home > CT coronary angiography, Journal Club > Journal Club 4 Decembe 2013

Journal Club 4 Decembe 2013

Paper

Optimized Prognostic Score for Coronary Computed Tomographic Angiography Results From the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry)

Presenter

JFY

Summary

Objectives

The aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and
to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with
suspected coronary artery disease (CAD).
Background Coronary computed tomography angiography carries important prognostic information in addition to the detection of
obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk
predictors.

Methods

The analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with
suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An
InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was
modeled. The endpoint was all-cause mortality.

Results

During a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was
the number of proximal segments with mixed or calcified plaques (C-index 0.64, p 50% (C-index 0.56, p ¼ 0.002). In an optimized score including both
parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or
a stenosis >50% is equivalent to a 5-year increase in age or the risk of smoking.

Conclusions

In CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A
prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.

Supplementary Related Material

Editorial by Dr. J. Younger
Template of risk score
CT aggregate plaque volume to assess hemodynamic significance of intermediate lesions

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