Author + information
- Ji Hyun Lee,
- Mahn Won Park,
- Briain O. Hartaigh,
- Asim Rizvi,
- Donghee Han,
- Hadi Mirhedayati Roudsari,
- Subhi Al'Aref,
- Khalil Anchouche,
- Ashley Beecy,
- Heidi Gransar,
- Hyung Bok Park,
- Jessica M. Peña,
- James Min,
- Fay Lin,
- on behalf of the CONFIRM Investigators
Background: Patients with renal impairment have a high burden of coronary plaque, and the clinical significance of abnormal coronary CT angiography (CCTA) is not determined. We assessed whether CCTA augments prediction of adverse outcomes beyond coronary artery calcium score (CACS) in patients with renal impairment.
Methods: We identified 9,964 patients without known CAD, with renal impairment (estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m2 by the MDRD equation), and both CACS and CCTA from the 27,125 patients in the CONFIRM registry. Categories of eGFR were: 60-89 (n=5,880) and <60 ml/min/1.73m2 (n=1,114). CACS was categorized as: 0, 1-100, 101-400, and >400, and CAD severity by CCTA was graded by no CAD (normal), nonobstructive CAD (coronary stenosis <50%), and obstructive CAD (coronary stenosis ≥50%). Multivariable Cox regression, discrimination by use of C-statistic, and category-free net reclassification improvement (cNRI) were estimated for major adverse cardiac events (MACE), comprising all-cause death, non-fatal myocardial infarction, and late target vessel revascularization (≥90 days).
Results: Mean age was 57.8±10.5 years, and 48.2% were women. After a median 2.2 years (IQR: 1.4-3.6 years) follow-up, 216 (3.1%) experienced MACE. Incidence of MACE increased on the background of a higher Framingham 10-year risk score (FRS), CACS, and CAD severity, regardless of eGFR category. Following adjustment, CACS and CAD severity categories were robust predictors of MACE among eGFR subsets. Within eGFR subsets of 60-89 and <60, CACS >400 increased the hazard for MACE by 7.1 (95% CI: 4.3-11.8) and 7.0 (95% CI: 3.1-15.7) as compared with zero CACS. Those with obstructive CAD had a 16.3- (95% CI: 9.6-27.7) and 15.3-fold (95% CI: 5.8-40.2) increased risk of MACE compared with no CAD. Notably, CCTA improved discrimination and reclassification beyond FRS and CACS for predicting MACE, independent of eGFR subsets (e.g., C-statistic: 0.81 vs. 0.74, cNRI: 0.76 for eGFR 60-89, and C-statistic: 0.81 vs. 0.73, cNRI: 0.84 for eGFR <60, P <0.001 for all).
Conclusions: CCTA improves prediction of MACE beyond FRS and CACS in patients with renal impairment, irrespective of eGFR status.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Non Invasive Imaging: Coronary Calcium Scoring and CV Risk Assessment
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1198-242
- 2017 American College of Cardiology Foundation