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Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study

2016; Elsevier BV; Volume: 231; Linguagem: Inglês

10.1016/j.ijcard.2016.12.137

1874-1754

Daniele Andreini, Gianluca Pontone, Saima Mushtaq, Heidi Gransar, Edoardo Conte, Antonio L. Bartorelli, Mauro Pepi, Maksymilian P. Opolski, Bríain ó Hartaigh, Daniel S. Berman, Matthew J. Budoff, Stephan Achenbach, Mouaz H. Al‐Mallah, Filippo Cademartiri, Tracy Q. Callister, Hyuk‐Jae Chang, Kavitha M. Chinnaiyan, Benjamin J.W. Chow, Ricardo Cury, Augustin DeLago, Martin Hadamitzky, Jöerg Hausleiter, Gudrun Feuchtner, Yong‐Jin Kim, Philipp A. Kaufmann, Jonathon Leipsic, Fay Y. Lin, Erica Maffei, Gilbert Raff, Leslee J. Shaw, Todd C. Villines, Allison Dunning, Hugo Marques, Ronen Rubinshtein, Niree Hindoyan, Millie Gomez, James K. Min,

Coronary Interventions and Diagnostics

Background Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). Methods From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality. Results Patient mean age was 56 ± 12 years. At follow-up (mean 59.8 ± 13.9 months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not. Conclusion CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.