title: Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease.
abstract: OBJECTIVE
  We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA).
  
  
  BACKGROUND
  Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes.
  
  
  METHODS
  We evaluated a consecutive cohort of 24,775 patients undergoing ≥64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (≥70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models.
  
  
  RESULTS
  At a 2.3 ± 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age <65 years versus ≥65 years, younger patients experienced higher hazards for death for 2-vessel (HR: 4.00; 95% CI: 2.16 to 7.40; p < 0.0001 vs. HR: 2.46; 95% CI: 1.51 to 4.02; p = 0.0003) and 3-vessel (HR: 6.19; 95% CI: 3.43 to 11.2; p < 0.0001 vs. HR: 3.10; 95% CI: 1.95 to 4.92; p < 0.0001) CAD. The relative hazard for 3-vessel CAD (HR: 4.21; 95% CI: 2.47 to 7.18; p < 0.0001 vs. HR: 3.27; 95% CI: 1.96 to 5.45; p < 0.0001) was higher for women as compared with men.
  
  
  CONCLUSIONS
  Among individuals without known CAD, nonobstructive and obstructive CAD by CCTA are associated with higher rates of mortality, with risk profiles differing for age and sex. Importantly, absence of CAD is associated with a very favorable prognosis.
authors.affiliation: Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. james.min@cshs.org
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Victor
authors.initials: V
authors.lastname: Cheng
authors.forename: Kavitha
authors.initials: K
authors.lastname: Chinnaiyan
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
authors.forename: Augustin
authors.initials: A
authors.lastname: Delago
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.forename: Joerg
authors.initials: J
authors.lastname: Hausleiter
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaufmann
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Todd
authors.initials: T
authors.lastname: Villines
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed