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

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Circ Cardiovasc Imaging


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:

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: Unique identifier: NCT01443637.

Medical Subject Headings

Adult; Age Factors; Aged; Canada; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Europe; 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; Risk Factors; Severity of Illness Index; Sex Factors; United States

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