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1. Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry

Author

Gebhard, C. (Catherine), Fuchs, T.A. (Tobias A.), Stehli, J. (Julia), Gransar, H. (Heidi), Berman, D.S. (Daniel S.), Budoff, M.J. (Matthew), Achenbach, S. (Stephan), Al-Mallah, M. (Mouaz), Andreini, D. (Daniele), Cademartiri, F. (Filippo), Callister, T.Q. (Tracy), Chang, H.-J. (Hyuk-Jae), Chinnaiyan, K. (Kavitha), Chow, B.J.W. (Benjamin), Cury, R.C. (Ricardo), Delago, A. (Augustin), Gomez, M. (Millie), Hadamitzky, M. (Martin), Hausleiter, J. (Jörg), Hindoyan, N. (Niree), Feuchtner, G. (Gudrun), Kim, Y.-J. (Yong-Jin), Leipsic, J. (Jonathon), Lin, F.Y. (Fay), Maffei, E. (Erica), Pontone, G. (Gianluca), Raff, G.L. (Gilbert), Shaw, L.J. (Leslee), Villines, T.C. (Todd), Dunning, A.M. (Allison M.), Min, J.K. (James), Kaufmann, P.A. (Philipp), Gebhard, C. (Catherine), Fuchs, T.A. (Tobias A.), Stehli, J. (Julia), Gransar, H. (Heidi), Berman, D.S. (Daniel S.), Budoff, M.J. (Matthew), Achenbach, S. (Stephan), Al-Mallah, M. (Mouaz), Andreini, D. (Daniele), Cademartiri, F. (Filippo), Callister, T.Q. (Tracy), Chang, H.-J. (Hyuk-Jae), Chinnaiyan, K. (Kavitha), Chow, B.J.W. (Benjamin), Cury, R.C. (Ricardo), Delago, A. (Augustin), Gomez, M. (Millie), Hadamitzky, M. (Martin), Hausleiter, J. (Jörg), Hindoyan, N. (Niree), Feuchtner, G. (Gudrun), Kim, Y.-J. (Yong-Jin), Leipsic, J. (Jonathon), Lin, F.Y. (Fay), Maffei, E. (Erica), Pontone, G. (Gianluca), Raff, G.L. (Gilbert), Shaw, L.J. (Leslee), Villines, T.C. (Todd), Dunning, A.M. (Allison M.), Min, J.K. (James), and Kaufmann, P.A. (Philipp)

Abstract

Aims: Coronary computed tomographic angiography (CCTA) has become an important tool for non-invasive diagnosis of coronary artery disease (CAD). Coronary dominance can be assessed by CCTA; however, the predictive value of coronary dominance is controversially discussed. The aim of this study was to evaluate the prevalence and prognosis of coronary dominance in a large prospective, international multicentre cohort of patients undergoing CCTA. Methods and results: The study population consisted of 6382 patients with or without CAD (47% females, 53% males, mean age 56.9±12.3 years) who underwent CCTA and were followed over a period of 60 months. Right or left coronary dominance was determined. Right dominance was present in 91% (n = 5817) and left in 9% (n = 565) of the study population. At the end of follow-up, outcome in patients with obstructive CAD (>50% luminal stenosis) and right dominance was similar compared with patients with left dominance [hazard ratio (HR) 0.46, 95% CI 0.16-1.32, P = 0.15]. Furthermore, no differences were observed for the type of coronary dominance in patients with non-obstructive CAD(HR 0.95, 95% CI 0.41-2.21, P = 0.8962) or normal coronary arteries (HR 1.04, 95% CI 0.68-1.59, P = 0.9). Subgroup analysis in patients with left main disease revealed an elevated hazard of the combined endpoint for left dominance (HR 6.45, 95% CI 1.66-25.0, P = 0.007), but not for right dominance. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith left or right coronary dominance. Thus, assessment of coronary vessel dominance by CCTA may not enhance risk stratification in patients with normal coronary arteries or obstructive CAD, but may add prognostic information for specific subpopulations.

Published
2015
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2. Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study

Author

Cho, I. (Iksung), Chang, H.-J. (Hyuk-Jae), Hartaigh, B.T. (Bríain ó), Shin, S. (Sanghoon), Sung, J.M. (Ji Min), Lin, F.Y. (Fay), Achenbach, S. (Stephan), Heo, R. (Ran), Berman, D.S. (Daniel), Budoff, M.J. (Matthew J.), Callister, T.Q. (Tracy), Al-Mallah, M. (Mouaz), Cademartiri, F. (Filippo), Chinnaiyan, K. (Kavitha), Chow, B.J.W. (Benjamin), Dunning, A.M. (Allison M.), Delago, A. (Augustin), Villines, T.C. (Todd), Hadamitzky, M. (Martin), Hausleiter, J. (Jörg), Leipsic, J. (Jonathon), Shaw, L.J. (Leslee), Kaufmann, P.A. (Philipp A.), Cury, R.C. (Ricardo), Feuchtner, G.M. (Gudrun), Kim, Y.-J. (Yong-Jin), Maffei, E. (Erica), Raff, G.L. (Gilbert), Pontone, G. (Gianluca), Andreini, D. (Daniele), Min, J.K. (James K.), Cho, I. (Iksung), Chang, H.-J. (Hyuk-Jae), Hartaigh, B.T. (Bríain ó), Shin, S. (Sanghoon), Sung, J.M. (Ji Min), Lin, F.Y. (Fay), Achenbach, S. (Stephan), Heo, R. (Ran), Berman, D.S. (Daniel), Budoff, M.J. (Matthew J.), Callister, T.Q. (Tracy), Al-Mallah, M. (Mouaz), Cademartiri, F. (Filippo), Chinnaiyan, K. (Kavitha), Chow, B.J.W. (Benjamin), Dunning, A.M. (Allison M.), Delago, A. (Augustin), Villines, T.C. (Todd), Hadamitzky, M. (Martin), Hausleiter, J. (Jörg), Leipsic, J. (Jonathon), Shaw, L.J. (Leslee), Kaufmann, P.A. (Philipp A.), Cury, R.C. (Ricardo), Feuchtner, G.M. (Gudrun), Kim, Y.-J. (Yong-Jin), Maffei, E. (Erica), Raff, G.L. (Gilbert), Pontone, G. (Gianluca), Andreini, D. (Daniele), and Min, J.K. (James K.)

Abstract

Aim Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown. Methods and results From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CA

Published
2015
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3. Is metabolic syndrome predictive of prevalence, extent, and risk of coronary artery disease beyond its components? results from the multinational coronary ct angiography evaluation for clinical outcome: An international multicenter registry (confirm)

Author

Ahmadi, A. (Amir), Leipsic, J. (Jonathon), Feuchtner, G.M. (Gudrun), Gransar, H. (Heidi), Kalra, D. (Dan), Heo, R. (Ran), Achenbach, S. (Stephan), Andreini, D. (Daniele), Al-Mallah, M. (Mouaz), Berman, D.S. (Daniel S.), Budoff, M.J. (Matthew), Cademartiri, F. (Filippo), Callister, T.Q. (Tracy), Chang, H.-J. (Hyuk-Jae), Chinnaiyan, K. (Kavitha), Chow, B.J.W. (Benjamin), Cury, R.C. (Ricardo), Delago, A. (Augustin), Gomez, M. (Millie), Hadamitzky, M. (Martin), Hausleiter, J. (Jörg), Hindoyan, N. (Niree), Kaufmann, P.A. (Philipp), Kim, Y.-J. (Yong-Jin), Lin, F.Y. (Fay), Maffei, E. (Erica), Pontone, G. (Gianluca), Raff, G.L. (Gilbert), Shaw, L.J. (Leslee), Villines, T.C. (Todd), Dunning, A.M. (Allison M.), Min, J.K. (James), Ahmadi, A. (Amir), Leipsic, J. (Jonathon), Feuchtner, G.M. (Gudrun), Gransar, H. (Heidi), Kalra, D. (Dan), Heo, R. (Ran), Achenbach, S. (Stephan), Andreini, D. (Daniele), Al-Mallah, M. (Mouaz), Berman, D.S. (Daniel S.), Budoff, M.J. (Matthew), Cademartiri, F. (Filippo), Callister, T.Q. (Tracy), Chang, H.-J. (Hyuk-Jae), Chinnaiyan, K. (Kavitha), Chow, B.J.W. (Benjamin), Cury, R.C. (Ricardo), Delago, A. (Augustin), Gomez, M. (Millie), Hadamitzky, M. (Martin), Hausleiter, J. (Jörg), Hindoyan, N. (Niree), Kaufmann, P.A. (Philipp), Kim, Y.-J. (Yong-Jin), Lin, F.Y. (Fay), Maffei, E. (Erica), Pontone, G. (Gianluca), Raff, G.L. (Gilbert), Shaw, L.J. (Leslee), Villines, T.C. (Todd), Dunning, A.M. (Allison M.), and Min, J.K. (James)

Abstract

Although metabolic syndrome is associated with increased risk of cardiovascular disease and events, its added prognostic value beyond its components remains unknown. This study compared the prevalence, severity of coronary artery disease (CAD), and prognosis of patients with metabolic syndrome to those with individual metabolic syndrome components. The study cohort consisted of 27125 consecutive individuals who underwent ≥64-detector row coronary CT angiography (CCTA) at 12 centers from 2003 to 2009. Metabolic syndrome was defined as per NCEP/ATP III criteria. Metabolic syndrome patients (n=690) were matched 1:1:1 to those with 1 component (n=690) and 2 components (n=690) of metabolic syndrome for age, sex, smoking status, and family history of premature CAD using propensity scoring. Major adverse cardiac events (MACE) were defined by a composite of myocardial infarction (MI), acute coronary syndrome, mortality and late target vessel revascularization. Patients with 1 component of metabolic syndrome manifested lower rates of obstructive 1-, 2-, and 3-vessel/left main disease compared to metabolic syndrome patients (9.4% vs 13.8%, 2.6% vs 4.5%, and 1.0% vs 2.3%, respectively; p<0.05), while those with 2 components did not (10.5% vs 13.8%, 2.8% vs 4.5% and 1.3% vs 2.3%, respectively; p>0.05). At 2.5 years, metabolic syndrome patients experienced a higher rate of MACE compared to patients with 1 component (4.4% vs 1.6%; p=0.002), while no difference observed compared to individuals with 2 components (4.4% vs 3.2% p=0.25) of metabolic syndrome. In conclusion, Metabolic syndrome patients have significantly greater prevalence, severity, and prognosis of CAD compared to patients with 1 but not 2 components of metabolic syndrome.

Published
2015
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