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ETHNIC DIFFERENCES OF CORONARY ATHEROSCLEROSIS IN COMPUTED TOMOGRAPHY ANGIOGRAPHY AND SUBSEQUENT RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS: THE CONFIRM REGISTRY
1596 JACC March 21, 2017 Volume 69, Issue 11
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) ETHNIC DIFFERENCES OF CORONARY ATHEROSCLEROSIS IN COMPUTED TOMOGRAPHY ANGIOGRAPHY AND SUBSEQUENT RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS: THE CONFIRM REGISTRY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1247-231 Authors: David Sanders, Aaron Jolly, Nathan D. Wong, Heidi Gransar, Mayil Krishnam, James K. Min, Daniel S. Berman, CONFIRM Study Group, UC Irvine Medical Center, Orange, CA, USA, Cedars Sinai Medical Center, Los Angeles, CA, USA Objectives: We examined the prevalence of obstructive coronary artery disease (CAD), plaque type, and associations with risk of major adverse cardiovascular events (MACE), across ethnicities (African American [AA], East Asian [EA], and Caucasian [CA]) in a large clinical registry. Background: The prevalence of CAD and incidence of MACE differs by ethnicity. Computed tomography angiography identifies CAD and plaque characteristics, but it is uncertain how plaque findings and their relationship to future MACE differ by ethnicity. Methods: 14,575 patients (mean age 58.1 ± 11.7 years, 6.0% AA, 34.5% EA, 59.6% CA) from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry were studied. Logistic regression examined the odds ratios (ORs) for obstructive CAD and plaque type (calcified, non-calcified, and mixed) by ethnicity. Cox regression provided hazard ratios (HRs) for the relation of obstructive disease and plaque type with MACE, including death, myocardial infarction, and unstable angina, across ethnicity with a follow-up of 3 years.
Results: The age, gender, and risk factor-adjusted odds of having obstructive CAD was lower for AA (OR 0.38 [0.30 – 0.49], p < 0.001) and EA (OR 0.82 [0.75 – 0.90], p < 0.001) compared to CA. AA and EA were more likely to have >1 calcified segments (OR 1.42 [1.07 – 1.88], p 0.015 and OR 1.72 [1.52 – 1.95], p <0.001 respectively) and less likely to have >1 non-calcified segments (OR 0.72 [0.55 – 0.95], p 0.022 and OR 0.43 [0.38 – 0.49], p < 0.001 respectively) compared to CA. There were 605 total MACE events with a cumulative incidence of 4.2%. There was a strong association of obstructive CAD with MACE by ethnicity (HR 2.57 [1.20 – 5.53], p 0.016 for AA, HR 7.93 [5.27 – 11.91], p <0.001 for EA, and HR 2.80 [2.26 – 3.46], p <0.001 for CA). For EA only, there was a strong relative hazard of MACE with 1 or more non-calcified segments (HR 2.81 [1.26 – 6.28], p 0.012). Conclusions: Obstructive CAD predicts MACE across several ethnic groups, but there are ethnic differences in plaque type and the relation to MACE. Further studies should examine how this might relate to understanding ethnic differences in MACE.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) ETHNIC DIFFERENCES OF CORONARY ATHEROSCLEROSIS IN COMPUTED TOMOGRAPHY ANGIOGRAPHY AND SUBSEQUENT RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS: THE CONFIRM REGISTRY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1247-231 Authors: David Sanders, Aaron Jolly, Nathan D. Wong, Heidi Gransar, Mayil Krishnam, James K. Min, Daniel S. Berman, CONFIRM Study Group, UC Irvine Medical Center, Orange, CA, USA, Cedars Sinai Medical Center, Los Angeles, CA, USA Objectives: We examined the prevalence of obstructive coronary artery disease (CAD), plaque type, and associations with risk of major adverse cardiovascular events (MACE), across ethnicities (African American [AA], East Asian [EA], and Caucasian [CA]) in a large clinical registry. Background: The prevalence of CAD and incidence of MACE differs by ethnicity. Computed tomography angiography identifies CAD and plaque characteristics, but it is uncertain how plaque findings and their relationship to future MACE differ by ethnicity. Methods: 14,575 patients (mean age 58.1 ± 11.7 years, 6.0% AA, 34.5% EA, 59.6% CA) from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry were studied. Logistic regression examined the odds ratios (ORs) for obstructive CAD and plaque type (calcified, non-calcified, and mixed) by ethnicity. Cox regression provided hazard ratios (HRs) for the relation of obstructive disease and plaque type with MACE, including death, myocardial infarction, and unstable angina, across ethnicity with a follow-up of 3 years.
Results: The age, gender, and risk factor-adjusted odds of having obstructive CAD was lower for AA (OR 0.38 [0.30 – 0.49], p < 0.001) and EA (OR 0.82 [0.75 – 0.90], p < 0.001) compared to CA. AA and EA were more likely to have >1 calcified segments (OR 1.42 [1.07 – 1.88], p 0.015 and OR 1.72 [1.52 – 1.95], p <0.001 respectively) and less likely to have >1 non-calcified segments (OR 0.72 [0.55 – 0.95], p 0.022 and OR 0.43 [0.38 – 0.49], p < 0.001 respectively) compared to CA. There were 605 total MACE events with a cumulative incidence of 4.2%. There was a strong association of obstructive CAD with MACE by ethnicity (HR 2.57 [1.20 – 5.53], p 0.016 for AA, HR 7.93 [5.27 – 11.91], p <0.001 for EA, and HR 2.80 [2.26 – 3.46], p <0.001 for CA). For EA only, there was a strong relative hazard of MACE with 1 or more non-calcified segments (HR 2.81 [1.26 – 6.28], p 0.012). Conclusions: Obstructive CAD predicts MACE across several ethnic groups, but there are ethnic differences in plaque type and the relation to MACE. Further studies should examine how this might relate to understanding ethnic differences in MACE.