Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry

Todd C. Villines; Edward A. Hulten; Leslee J. Shaw; Manju Goyal; Allison Dunning; Stephan Achenbach; Mouaz Al-Mallah; Daniel S. Berman; Matthew J. Budoff; Filippo Cademartiri; Tracy Q. Callister; Hyuk Jae Chang; Victor Y. Cheng; Kavitha Chinnaiyan; Benjamin J.W. Chow; Augustin Delago; Martin Hadamitzky; Jörg Hausleiter; Philipp Kaufmann; Fay Y. Lin; Erica Maffei; Gilbert L. Raff; James K. Min

doi:10.1016/j.jacc.2011.10.851

Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry

Todd C. Villines, Edward A. Hulten, Leslee J. Shaw, Manju Goyal, Allison Dunning, Stephan Achenbach, Mouaz Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Victor Y. Cheng, Kavitha Chinnaiyan, Benjamin J.W. Chow, Augustin Delago, Martin Hadamitzky, Jörg Hausleiter, Philipp Kaufmann, Fay Y. LinErica Maffei, Gilbert L. Raff, James K. Min

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

291 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). Background: The frequency and clinical relevance of CAD in patients without CAC are unclear. Methods: We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. Results: Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). Conclusions: In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.

Original language	English
Pages (from-to)	2533-2540
Number of pages	8
Journal	Journal of the American College of Cardiology
Volume	58
Issue number	24
DOIs	https://doi.org/10.1016/j.jacc.2011.10.851
Publication status	Published - 2011 Dec 6

Bibliographical note

Funding Information:
The views expressed here are those of the authors only, and are not to be construed as those of the Department of the Army or Department of Defense. Dr. Villines has received speaker honoraria from Boehringer-Ingelheim. Dr. Achenbach has received grant support from Siemens and Bayer Schering Pharma . Dr. Budoff has received speaker honoraria from GE Healthcare. Dr. Cademartiri has received grant support from GE Healthcare ; and speaker honoraria from Bracco Diagnostics. Dr. Callister is on the Speaker's Bureau of GE Healthcare. Dr. Chinnaiyan has received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI . Dr. Chow has received research support from GE Healthcare, Pfizer, and AstraZeneca; and educational support from TeraRecon. Dr. Hausleiter has received research grant support from Siemens . Dr. Kaufmann has received research support from GE Healthcare; and grant support from the Swiss National Science Foundation . Dr. Maffei has received grant support from GE Healthcare ; and is a consultant for Servier. Dr. Raff has received grant support from Siemens , Blue Cross Blue Shield Blue Care MI , and Bayer Pharma . Dr. Min has received speaker honoraria and research support and serves on the medical advisory board of GE Healthcare.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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Villines, T. C., Hulten, E. A., Shaw, L. J., Goyal, M., Dunning, A., Achenbach, S., Al-Mallah, M., Berman, D. S., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Cheng, V. Y., Chinnaiyan, K., Chow, B. J. W., Delago, A., Hadamitzky, M., Hausleiter, J., Kaufmann, P., ... Min, J. K. (2011). Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry. Journal of the American College of Cardiology, 58(24), 2533-2540. https://doi.org/10.1016/j.jacc.2011.10.851

Villines, Todd C. ; Hulten, Edward A. ; Shaw, Leslee J. et al. / Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography : Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry. In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 24. pp. 2533-2540.

@article{190e52003b0447878466dc91dace00cf,

title = "Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry",

abstract = "Objectives: The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). Background: The frequency and clinical relevance of CAD in patients without CAC are unclear. Methods: We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. Results: Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). Conclusions: In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.",

author = "Villines, {Todd C.} and Hulten, {Edward A.} and Shaw, {Leslee J.} and Manju Goyal and Allison Dunning and Stephan Achenbach and Mouaz Al-Mallah and Berman, {Daniel S.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Cheng, {Victor Y.} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Augustin Delago and Martin Hadamitzky and J{\"o}rg Hausleiter and Philipp Kaufmann and Lin, {Fay Y.} and Erica Maffei and Raff, {Gilbert L.} and Min, {James K.}",

note = "Funding Information: The views expressed here are those of the authors only, and are not to be construed as those of the Department of the Army or Department of Defense. Dr. Villines has received speaker honoraria from Boehringer-Ingelheim. Dr. Achenbach has received grant support from Siemens and Bayer Schering Pharma . Dr. Budoff has received speaker honoraria from GE Healthcare. Dr. Cademartiri has received grant support from GE Healthcare ; and speaker honoraria from Bracco Diagnostics. Dr. Callister is on the Speaker's Bureau of GE Healthcare. Dr. Chinnaiyan has received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI . Dr. Chow has received research support from GE Healthcare, Pfizer, and AstraZeneca; and educational support from TeraRecon. Dr. Hausleiter has received research grant support from Siemens . Dr. Kaufmann has received research support from GE Healthcare; and grant support from the Swiss National Science Foundation . Dr. Maffei has received grant support from GE Healthcare ; and is a consultant for Servier. Dr. Raff has received grant support from Siemens , Blue Cross Blue Shield Blue Care MI , and Bayer Pharma . Dr. Min has received speaker honoraria and research support and serves on the medical advisory board of GE Healthcare. ",

year = "2011",

month = dec,

day = "6",

doi = "10.1016/j.jacc.2011.10.851",

language = "English",

volume = "58",

pages = "2533--2540",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "24",

}

Villines, TC, Hulten, EA, Shaw, LJ, Goyal, M, Dunning, A, Achenbach, S, Al-Mallah, M, Berman, DS, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Cheng, VY, Chinnaiyan, K, Chow, BJW, Delago, A, Hadamitzky, M, Hausleiter, J, Kaufmann, P, Lin, FY, Maffei, E, Raff, GL & Min, JK 2011, 'Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry', Journal of the American College of Cardiology, vol. 58, no. 24, pp. 2533-2540. https://doi.org/10.1016/j.jacc.2011.10.851

Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry. / Villines, Todd C.; Hulten, Edward A.; Shaw, Leslee J. et al.
In: Journal of the American College of Cardiology, Vol. 58, No. 24, 06.12.2011, p. 2533-2540.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography

T2 - Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry

AU - Villines, Todd C.

AU - Hulten, Edward A.

AU - Shaw, Leslee J.

AU - Goyal, Manju

AU - Dunning, Allison

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Cheng, Victor Y.

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Delago, Augustin

AU - Hadamitzky, Martin

AU - Hausleiter, Jörg

AU - Kaufmann, Philipp

AU - Lin, Fay Y.

AU - Maffei, Erica

AU - Raff, Gilbert L.

AU - Min, James K.

N1 - Funding Information: The views expressed here are those of the authors only, and are not to be construed as those of the Department of the Army or Department of Defense. Dr. Villines has received speaker honoraria from Boehringer-Ingelheim. Dr. Achenbach has received grant support from Siemens and Bayer Schering Pharma . Dr. Budoff has received speaker honoraria from GE Healthcare. Dr. Cademartiri has received grant support from GE Healthcare ; and speaker honoraria from Bracco Diagnostics. Dr. Callister is on the Speaker's Bureau of GE Healthcare. Dr. Chinnaiyan has received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI . Dr. Chow has received research support from GE Healthcare, Pfizer, and AstraZeneca; and educational support from TeraRecon. Dr. Hausleiter has received research grant support from Siemens . Dr. Kaufmann has received research support from GE Healthcare; and grant support from the Swiss National Science Foundation . Dr. Maffei has received grant support from GE Healthcare ; and is a consultant for Servier. Dr. Raff has received grant support from Siemens , Blue Cross Blue Shield Blue Care MI , and Bayer Pharma . Dr. Min has received speaker honoraria and research support and serves on the medical advisory board of GE Healthcare.

PY - 2011/12/6

Y1 - 2011/12/6

N2 - Objectives: The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). Background: The frequency and clinical relevance of CAD in patients without CAC are unclear. Methods: We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. Results: Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). Conclusions: In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.

AB - Objectives: The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). Background: The frequency and clinical relevance of CAD in patients without CAC are unclear. Methods: We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. Results: Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). Conclusions: In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.

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