Author + information
- Chadi Ayouba,b,
- Fernanda Erthala,b,
- Mahmoud Abdelsalama,b,
- Mohammad H. Murada,b,
- Zhen Wanga,b,
- Patricia Erwina,b,
- Graham S. Hillisa,b,
- Leonard Kritharidesa,b and
- Benjamin Chowa,b
Background: The independent prognostic value of the extent of coronary atherosclerosis burden on coronary computed tomography angiography (CCTA), as measured by segment involvement score (SIS), is uncertain. We performed a systematic review and meta-analysis to evaluate the prognostic value of SIS, and compared to that of coronary artery calcium score (CAC), obstructive coronary artery disease (CAD) and plaque composition.
Methods: Electronic databases from 1946 to January 2016 were searched. We included studies on adults who had evaluation by CCTA and reported SIS or an equivalent measure, and clinical outcomes. Maximally adjusted hazard ratios (HR) for SIS, obstructive CAD, CAC, and plaque composition were extracted from the included studies and pooled using DerSimonian-Laird random effects models.
Results: A total of 2,865 citations were identified for review. We included 11 non-randomized studies with good methodological quality enrolling 9,777 subjects (mean age 61 ± 11 years, 57% male) who had 472 (4.8%) MACE (cardiac or all cause death, non-fatal myocardial infarction or late revascularization) and 167 (1.7%) all-cause mortality events, with a mean follow up of 3.3 years (mean range: 1.3 – 6.9 years). SIS (per segment change) had pooled, maximally adjusted HR of 1.25 (95% confidence interval [CI]: 1.16, 1.35; I2=71.4%) for MACE, and 1.06 (95% CI: 0.91, 1.35; I2=65.3%) for all-cause mortality. Presence of obstructive CAD and CAC score (per unit change) were associated with HRs for MACE of 3.39 (95% CI: 1.65, 6.99; I2=87.8%) and 1.00 (95% CI: 1.00, 1.01; I2=75.0%), respectively. HRs by plaque composition (calcified, non-calcified and mixed) were 1.24 (95% CI: 1.10, 1.39; I2=81.6%), 1.20 (95% CI: 0.97, 1.48; I2=92.9%) and 1.27 (95% CI: 1.03, 1.58; I2=89.8%), respectively. Patients with higher SIS category (defined as disease in ≥5, >5 or >4 segments depending on the study) had markedly higher risk of clinical events than those with lower category SIS.
Conclusions: Presence of obstructive CAD on CCTA is associated with highest risk for MACE. Despite heterogeneity in endpoints, extent of CAD as quantified by SIS on CCTA is a strong, independent predictor of mortality and cardiovascular events.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1247-234
- 2017 American College of Cardiology Foundation