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S R Gnanenthiran, C Naoum, J A Leipsic, L Kritharides, J K Min, the Primary authors of the CONFIRM Investigators, P2487
Long term prognostic utility of CT Coronary Angiography (CTCA) in older populations, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy565.P2487, https://doi.org/10.1093/eurheartj/ehy565.P2487Close - Share Icon Share
Extract
Background: The long-term prognostic value of CTCA-identified coronary artery disease (CAD) has not been validated in elderly patients (≥70yrs). We compared the ability of coronary CTCA to predict 5-year mortality in older vs. younger populations.
Methods: From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CTCA results according to age <70yrs (n=7,198, 57% male) vs. ≥70yrs (n=1,786, 46% male). The severity of CAD was classified according to maximal stenosis degree per vessel as none (0%), non-obstructive (1–49%) or obstructive (>50%). Cox-proportional hazard models assessed the relationship between CTCA findings and time to mortality, adjusting for sex and clinical risk factors. Major adverse cardiovascular events (MACE) were assessed in a subgroup (n=4,413).
Results: At a mean 5.6±1.1yr follow-up, CTCA-identified CAD predicted increased mortality compared to patients with a normal CTCA in both <70yrs [non-obstructive HR (CI): 1.70 (1.19–2.41); one-vessel: 1.65 (1.30–2.67); two-vessel: 2.24 (1.21–4.15); three-vessel/left main: 4.12 (2.27–7.46), p<0.001] and ≥70yrs [non-obstructive: 1.84 (1.15–2.95); one-vessel: HR (CI): 2.28 (1.37–3.81); two-vessel: 2.36 (1.33–4.19); three-vessel/left main: 2.41 (1.33–4.36), p=0.014]. CTCA findings similarly predicted long-term MACE in both groups. In a subgroup of very elderly patients ≥75yrs, CTCA remained predictive of MACE (n=417) [non-obstructive HR 1.60 (0.90–2.83); one-vessel: 2.15 (1.13–4.08); two-vessel: 3.51 (1.75–7.01); three-vessel/left main: 2.42 (1.19–4.92), p=0.001], but not mortality (n=956) [non-obstructive 1.39 (0.81–2.36); one-vessel: 1.54 (0.86–2.76); two-vessel: 1.60 (0.84–3.04); three-vessel/left main: 1.67 (0.87–3.20), p=0.55] after adjustment for clinical risk factors.
