Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study

• Published in: European heart journal Vol. 38; no. 6; pp. 413 - 421
• Main Authors: Nielsen, Lene H, Bøtker, Hans Erik, Sørensen, Henrik T, Schmidt, Morten, Pedersen, Lars, Sand, Niels Peter, Jensen, Jesper M, Steffensen, Flemming H, Tilsted, Hans Henrik, Bøttcher, Morten, Diederichsen, Axel, Lambrechtsen, Jess, Kristensen, Lone D, Øvrehus, Kristian A, Mickley, Hans, Munkholm, Henrik, Gøtzsche, Ole, Husain, Majed, Knudsen, Lars L, Nørgaard, Bjarne L
• Format: Journal Article
• Language: English
• Published: England 07-02-2017
• Subjects: Adult; Aged; Angina, Stable - diagnostic imaging; Angina, Stable - mortality; Cohort Studies; Computed Tomography Angiography - mortality; Coronary Angiography - mortality; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Denmark - epidemiology; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Revascularization - mortality; Percutaneous Coronary Intervention - mortality; Prognosis; Prognosis; Coronary atherosclerosis; Comorbidity; Coronary computed tomography angiography; Stable angina
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehw548

To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity.
This cohort study included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death. The Kaplan-Meier estimator was used to compute 91 day to 3.5 year risk according to the CAD severity. Comparisons between patients with and without CAD were based on Cox-regression adjusted for age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac medications, and post-CCTA treatment within 90 days. The composite endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5% for patients without CAD, 6.8% for obstructive CAD, and 15% for three-vessel/left main disease. Compared with patients without CAD, higher relative risk of the composite endpoint was observed for non-obstructive CAD [hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.01-1.63], obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95% CI :2.90-6.69). The results were consistent in strata of age, sex, and comorbidity.
Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.