TY - JOUR
T1 - 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])
AU - Han, Donghee
AU - Beecy, Ashley
AU - Anchouche, Khalil
AU - Gransar, Heidi
AU - Dunham, Patricia C.
AU - Lee, Ji Hyun
AU - Achenbach, Stephan
AU - Al-Mallah, Mouaz H.
AU - Andreini, Daniele
AU - Berman, Daniel S.
AU - Bax, Jeroen J.
AU - Budoff, Matthew J.
AU - Cademartiri, Filippo
AU - Callister, Tracy Q.
AU - Chang, Hyuk Jae
AU - Chinnaiyan, Kavitha
AU - Chow, Benjamin J.W.
AU - Cury, Ricardo C.
AU - DeLago, Augustin
AU - Feuchtner, Gudrun
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Kaufmann, Philipp A.
AU - Kim, Yong Jin
AU - Leipsic, Jonathon A.
AU - Maffei, Erica
AU - Marques, Hugo
AU - de Araújo Gonçalves, Pedro
AU - Pontone, Gianluca
AU - Raff, Gilbert L.
AU - Rubinshtein, Ronen
AU - Villines, Todd C.
AU - Lu, Yao
AU - Peña, Jessica M.
AU - Shaw, Leslee J.
AU - Min, James K.
AU - Lin, Fay Y.
N1 - Funding Information:
Funding: The research reported in this publication was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150. This research was also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA).
Funding Information:
Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Benjamin Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research. He receives research support from CV Diagnostix and Ausculsciences, educational support from TeraRecon Inc. and has equity interest in General Electric. Dr. Kavitha Chinnaiyan is a noncompensated medical advisory board member of Heartflow Inc. All other authors have no relevant disclosures.
Publisher Copyright:
© 2019
PY - 2019/11/1
Y1 - 2019/11/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85072519688&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2019.07.045
DO - 10.1016/j.amjcard.2019.07.045
M3 - Article
C2 - 31547994
AN - SCOPUS:85072519688
SN - 0002-9149
VL - 124
SP - 1397
EP - 1405
JO - The American journal of cardiology
JF - The American journal of cardiology
IS - 9
ER -
