Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events
Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events
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DOI：
10.1161/circimaging.116.004896
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发表时间：
2017-03-01
影响因子：
7.5
通讯作者：
Leipsic, Jonathon
中科院分区：
文献类型：
--
作者：
Naoum, Christopher;Berman, Daniel S.;Leipsic, Jonathon
冠状动脉计算机断层扫描血管造影确定的年龄校正的冠状动脉疾病（CAD）负担预测主要不良心血管事件（MACE）风险;然而，由于缺乏列线图数据，它很少有助于临床决策。我们的目的是使用冠状动脉计算机断层扫描血管造影术开发临床实用的年龄和性别特异性CAD负荷列线图，并验证其预后用途。（临床结局的冠状动脉CT血管造影评价）（衍生队列：n= 21，132; 46%女性），以根据每个生命年（40-79岁）的节段受累评分（SIS）的年龄-性别比值绘制CAD列线图。SIS年龄性别比（SIS%）与MACE的关系（全因死亡、心肌梗死、不稳定型心绞痛和晚期血运重建）在一个非重叠验证队列中进行检验（第二阶段，CONFIRM登记; n=3030，44%女性），将患者分为3个SIS%组（第75组）以及使用多变量考克斯比例风险模型比较年度MACE率和MACE时间，该模型调整了心脏病风险和胸痛典型性。两性间的曲线与二阶多项式曲线拟合良好（男性：R-2=0.86 +/- 0.12;女性：R-2=0.86 +/- 0.14）。使用列线图，在第75个SIS%组中分别有1576、965和489例患者。冠心病负荷较大的患者的年事件发生率较高（第50、51- 75和> 75 th SIS%组分别为2.1% [95%置信区间：1.7%-2.7%]、3.9% [95%置信区间：3.0%-5.1%]和7.2% [95%置信区间：5.4%-9.6%]; P <75 th SIS %组; P <0.05）。
Background-Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use.Methods and Results-Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R-2=0.86 +/- 0.12; women: R-2=0.86 +/- 0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the 75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in 50th, 51-75th, and >75th SIS% groups, respectively; P75th SIS% group; P