Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age

Chadi Ayoub, Leonard Kritharides, Yeung Yam, Li Chen, Alomgir Hossain, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Ricardo C. Cury, Augustin Delago, Allison Dunning, Gudrun Feuchtner, Millie Gomez, Heidi GransarMartin Hadamitzky, Joerg Hausleiter, Niree Hindoyan, Philipp A. Kaufmann, Yong Jin Kim, Jonathon Leipsic, Erica Maffei, Hugo Marques, Gianluca Pontone, Gilbert Raff, Ronen Rubinshtein, Leslee J. Shaw, Todd C. Villines, James K. Min, Benjamin J.W. Chow

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of ‘age adjusted SIS’ (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7 years, 55.8% male) with a median follow-up of 27.3 months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83–3.16, p < 0.001), C-statistic 0.723 (0.700–0.756), net reclassification improvement (NRI) 0.36 (0.26–0.47, p < 0.001), and relative integrated discrimination improvement (IDI) 0.33 (p = 0.009). aSIS had HR 3.48 (2.33–5.18, p < 0.001) for mortality in those without obstructive CAD, compared to HR 1.79 (1.25–2.58, p = 0.02) in those with obstructive CAD. In conclusion, aSIS has an incremental prognostic value to traditional risk factors and obstructive CAD, and may enhance CCTA risk stratification.

Original languageEnglish
Pages (from-to)1288-1300
Number of pages13
JournalHeart and Vessels
Issue number11
Publication statusPublished - 2018 Nov

Bibliographical note

Publisher Copyright:
© Springer Japan KK, part of Springer Nature 2018.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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