Publication

Back to overview

Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Publication date 2011
Author Villines Todd C, Hulten Edward A, Shaw Leslee J, Goyal Manju, Dunning Allison, Achenbach Stephan, Al-Mallah Mouaz, Berman Daniel S, Budoff Matthew J, Cademartiri Filippo, Callister Tracy Q, Chang Hyuk-Jae, Cheng Victor Y, Chinnaiyan Kavitha, Chow Benjamin J W, Delago Augustin, Hadamitzky Martin, Hausleiter Jörg, Kaufmann Philipp, Lin Fay Y, Maffei Erica, Raff Gilbert L, Min James K, CONFIRM Registry Investigators,
Project Entwicklung einer neuen Hybrid-Bildgebungs-Methode zur nicht invasiven kardialen Diagnostik
Show all

Original article (peer-reviewed)

Journal Journal of the American College of Cardiology
Volume (Issue) 58(24)
Page(s) 2533 - 40
Title of proceedings Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2011.10.851

Abstract

OBJECTIVES The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). BACKGROUND The frequency and clinical relevance of CAD in patients without CAC are unclear. METHODS We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. RESULTS Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). CONCLUSIONS In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.
-