Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM]). Academic Article uri icon

Overview

abstract

  • The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p >0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA.

authors

  • Han, Donghee
  • Beecy, Ashley
  • Anchouche, Khalil
  • Gransar, Heidi
  • Dunham, Patricia C
  • Lee, Ji-Hyun
  • Achenbach, Stephan
  • Al-Mallah, Mouaz H
  • Andreini, Daniele
  • Berman, Daniel S
  • Bax, Jeroen J
  • Budoff, Matthew J
  • Cademartiri, Filippo
  • Callister, Tracy Q
  • Chang, Hyuk-Jae
  • Chinnaiyan, Kavitha
  • Chow, Benjamin J W
  • Cury, Ricardo C
  • DeLago, Augustin
  • Feuchtner, Gudrun
  • Hadamitzky, Martin
  • Hausleiter, Joerg
  • Kaufmann, Philipp A
  • Kim, Yong-Jin
  • Leipsic, Jonathon A
  • Maffei, Erica
  • Marques, Hugo
  • de Araújo Gonçalves, Pedro
  • Pontone, Gianluca
  • Raff, Gilbert L
  • Rubinshtein, Ronen
  • Villines, Todd C
  • Lu, Yao
  • Pena, Jessica M.
  • Shaw, Leslee J
  • Min, James K
  • Lin, Fay Y

publication date

  • August 23, 2019

Research

keywords

  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Vessels
  • Practice Guidelines as Topic
  • Registries
  • Risk Assessment

Identity

Scopus Document Identifier

  • 85072519688

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2019.07.045

PubMed ID

  • 31547994

Additional Document Info

volume

  • 124

issue

  • 9