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PROGNOSTIC UTILITY OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY BEYOND CORONARY ARTERY CALCIUM SCORE IN DIABETIC PATIENTS WITH NO SYMPTOMS OR NON-TYPICAL CHEST PAIN: THE CONFIRM REGISTRY
1597 JACC March 21, 2017 Volume 69, Issue 11
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) PROGNOSTIC UTILITY OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY BEYOND CORONARY ARTERY CALCIUM SCORE IN DIABETIC PATIENTS WITH NO SYMPTOMS OR NONTYPICAL CHEST PAIN: 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: 1247-232 Authors: Mahn Won Park, Ji Hyun Lee, Briain O. Hartaigh, Asim Rizvi, Donghee Han, Hadi Mirhedayati Roudsari, Subhi Al’Aref, Khalil Anchouche, Ashley Beecy, Yao Lu, Heidi Gransar, Jessica Pena, James Min, Fay Lin, on behalf of the CONFIRM Investigators, Dalio Institute of Cardiovascular Imaging, New York, NY, USA
Background: Symptoms of chest pain in diabetic patients can vary substantially. To date, information is sparse regarding the incremental value of coronary computed tomographic angiography (CCTA) above coronary artery calcium score (CACS) and conventional risk factors in diabetic patients with no symptoms or non-typical chest pain. Methods: From the prospective CONFIRM registry of 35,281 patients with CCTA, 1,295 diabetic patients with no symptoms or nontypical chest pain (atypical or non-cardiac chest pain) were identified. Obstructive coronary artery disease (CAD) defined as coronary stenosis ≥50% and number of obstructive vessels were evaluated by CCTA. Patients were followed for a primary composite endpoint of major adverse cardiovascular events (MACE) that consisted of all-cause death, non-fatal myocardial infarction and late target vessel revascularization (≥90 days). The incremental value of CCTA for prognostication, discrimination by C-statistic, and reclassification by integrated discrimination improvement (IDI) were assessed.
Results: Mean age was 59.8±9.9 years and 55% were male. After a mean follow-up of 3.0±1.7 years, 103 (8.8%) diabetic patients experienced MACE (45 deaths, 15 non-fatal myocardial infarction, and 55 late revascularization). After adjustment for CAD risk factors and log CACS, obstructive CAD (HR 3.61, 95% CI: 1.34-3.33) and increasing number of obstructive vessels (HR 1.77, 95% CI: 1.442.15, Ptrend < 0.001) were significantly associated with MACE. Beyond the baseline model including age, gender and log CACS (C-statistic 0.77), CCTA improved discrimination (C-statistic 0.78 and 0.80 respectively) and risk reclassification (IDI 0.01 and 0.05 respectively) by obstructive CAD and number of obstructive vessels, P<0.05 for all. Conclusions: In diabetic patients with no symptoms or non-typical chest pain, CCTA-derived surrogates of CAD severity provide incremental prognostic value beyond CACS for prediction of MACE.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) PROGNOSTIC UTILITY OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY BEYOND CORONARY ARTERY CALCIUM SCORE IN DIABETIC PATIENTS WITH NO SYMPTOMS OR NONTYPICAL CHEST PAIN: 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: 1247-232 Authors: Mahn Won Park, Ji Hyun Lee, Briain O. Hartaigh, Asim Rizvi, Donghee Han, Hadi Mirhedayati Roudsari, Subhi Al’Aref, Khalil Anchouche, Ashley Beecy, Yao Lu, Heidi Gransar, Jessica Pena, James Min, Fay Lin, on behalf of the CONFIRM Investigators, Dalio Institute of Cardiovascular Imaging, New York, NY, USA
Background: Symptoms of chest pain in diabetic patients can vary substantially. To date, information is sparse regarding the incremental value of coronary computed tomographic angiography (CCTA) above coronary artery calcium score (CACS) and conventional risk factors in diabetic patients with no symptoms or non-typical chest pain. Methods: From the prospective CONFIRM registry of 35,281 patients with CCTA, 1,295 diabetic patients with no symptoms or nontypical chest pain (atypical or non-cardiac chest pain) were identified. Obstructive coronary artery disease (CAD) defined as coronary stenosis ≥50% and number of obstructive vessels were evaluated by CCTA. Patients were followed for a primary composite endpoint of major adverse cardiovascular events (MACE) that consisted of all-cause death, non-fatal myocardial infarction and late target vessel revascularization (≥90 days). The incremental value of CCTA for prognostication, discrimination by C-statistic, and reclassification by integrated discrimination improvement (IDI) were assessed.
Results: Mean age was 59.8±9.9 years and 55% were male. After a mean follow-up of 3.0±1.7 years, 103 (8.8%) diabetic patients experienced MACE (45 deaths, 15 non-fatal myocardial infarction, and 55 late revascularization). After adjustment for CAD risk factors and log CACS, obstructive CAD (HR 3.61, 95% CI: 1.34-3.33) and increasing number of obstructive vessels (HR 1.77, 95% CI: 1.442.15, Ptrend < 0.001) were significantly associated with MACE. Beyond the baseline model including age, gender and log CACS (C-statistic 0.77), CCTA improved discrimination (C-statistic 0.78 and 0.80 respectively) and risk reclassification (IDI 0.01 and 0.05 respectively) by obstructive CAD and number of obstructive vessels, P<0.05 for all. Conclusions: In diabetic patients with no symptoms or non-typical chest pain, CCTA-derived surrogates of CAD severity provide incremental prognostic value beyond CACS for prediction of MACE.