title: Usefulness of coronary computed tomography angiography to predict mortality and myocardial infarction among Caucasian, African and East Asian ethnicities (from the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter] Registry).
abstract: Studies examining coronary computed tomographic angiography (CCTA) have demonstrated increased mortality related to coronary artery disease (CAD) severity but are limited to relatively nondiverse ethnic populations. The aim of this study was to evaluate the prognostic significance of CAD on CCTA according to ethnicity for patients without previous CAD in a prospective international CCTA registry of 11 sites (7 countries) who underwent 64-slice CCTA from 2005 to 2010. CAD was defined as any coronary artery atherosclerosis and obstructive CAD as ≥50% stenosis. All-cause mortality and nonfatal myocardial infarction (MI) were assessed by ethnicity using Kaplan-Meier and Cox proportional hazards, controlling for baseline risk factors, medications, and revascularization. A total of 16,451 patients of mean age 58 years (55% men) were followed over a median of 2.0 years (interquartile range 1.4 to 3.2). Patients were 60.1% Caucasian, 34.4% East Asian, and 5.5% African. Death or MI occurred in 0.5% (38 of 7,109) among patients with no CAD, 1.6% (91 of 5,600) among those with nonobstructive CAD, and 3.8% (142 of 3,742) among those with ≥50% stenosis (p <0.001 among all groups). The annualized incidence of death or MI comparing obstructive to no obstructive CAD among Caucasians was 2.2% versus 0.7% (adjusted hazard ratio [aHR] 2.77, 95% confidence interval [CI] 1.73 to 4.43, p <0.001), among Africans 4.8% versus 1.1% (aHR 6.25, 95% CI 1.12 to 34.97, p = 0.037), and among East Asians 0.8% versus 0.1% (aHR 4.84, 95% CI 2.24 to 10.9, p <0.001). Compared to other ethnicities, East Asians had fewer than expected events (aHR 0.25, 95% CI 0.16 to 0.38, p <0.001). In conclusion, the presence and severity of CAD visualized by CCTA predict death or MI across 3 large ethnicities, whereas normal results on CCTA identify patients at very low risk.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA. ehulten@partners.org
authors.forename: Edward
authors.initials: E
authors.lastname: Hulten
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.forename: Michael K
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authors.lastname: Cheezum
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authors.initials: DS
authors.lastname: Berman
authors.forename: Allison
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authors.lastname: Dunning
authors.forename: Stephan
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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 Y
authors.initials: VY
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: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.forename: Augustin
authors.initials: A
authors.lastname: Delago
authors.forename: Gudrun
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authors.lastname: Feuchtner
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Karlsberg
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.forename: Fabian
authors.initials: F
authors.lastname: Plank
authors.forename: Gilbert L
authors.initials: GL
authors.lastname: Raff
authors.forename: Troy M
authors.initials: TM
authors.lastname: Labounty
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000349:Africa / Q000208:ethnology; D017023:Coronary Angiography / Q000379:methods*; D005006:Ethnicity; D005060:Europe / Q000453:epidemiology; D005202:Asia, Eastern / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014481:United States / Q000453:epidemiology