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])

Han D, Beecy A, Anchouche K, Gransar H, Dunham PC, Lee JH, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Bax JJ, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJ, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Lu Y, Peña JM, Shaw LJ, Min JK, Lin FY (2019)

Publication Type: Journal article

Publication year: 2019

Journal

DOI: 10.1016/j.amjcard.2019.07.045

Abstract

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.

Authors with CRIS profile

Involved external institutions

New York Presbyterian Hospital United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) The Methodist Hospital System United States (USA) (US) Centro Cardiologico Monzino (IRCCS) Italy (IT) Leiden University Medical Center Netherlands (NL) Los Angeles Biomedical Research Institute (LA BioMed) United States (USA) (US) SDN Istituto di Ricerca Diagnostica e Nucleare Italy (IT) Tennessee Heart & Vascular United States (USA) (US) Severance Hospital / 세브란스 병원 Korea, Republic of (KR) Beaumont Health United States (USA) (US) University of Ottawa Canada (CA) Baptist Health South Florida United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Medizinische Universität Innsbruck Austria (AT) Deutsches Herzzentrum München Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) University of Zurich / Universität Zürich (UZH) Switzerland (CH) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) University of British Columbia Canada (CA) Hospital da Luz Portugal (PT) Technion - Israel Institute of Technology Israel (IL) University of Virginia Health System United States (USA) (US)

How to cite

APA:

Han, D., Beecy, A., Anchouche, K., Gransar, H., Dunham, P.C., Lee, J.H.,... Lin, F.Y. (2019). 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]). American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2019.07.045

MLA:

Han, Donghee, et al. "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])." American Journal of Cardiology (2019).

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