title: Improved 5-year prediction of all-cause mortality by coronary CT angiography applying the CONFIRM score.
abstract: OBJECTIVE
  To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA).
  
  
  RESULTS
  Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality. The predictive value of the CONFIRM score over clinical risk scores (Morise, Framingham, and NCEP ATP III score) was studied in the entire patient population as well as in subgroups. Improvement in risk prediction and patient reclassification were assessed using categorical net reclassification index (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 5.3 years, 982 (6.5%) of 15 219 patients died. The CONFIRM score outperformed the prognostic value of the studied three clinical risk scores (c-indices: CONFIRM score 0.696, NCEP ATP III score 0.675, Framingham score 0.610, Morise score 0.606; c-index for improvement CONFIRM score vs. NCEP ATP III score 0.650, P < 0.0001). Application of the CONFIRM score allowed reclassification of 34% of patients when compared with the NCEP ATP III score, which was the best clinical risk score. Reclassification was significant as revealed by categorical NRI (0.06 with 95% CI 0.02 and 0.10, P = 0.005) and IDI (0.013 with 95% CI 0.01 and 0.015, P < 0.001). Subgroup analysis revealed a comparable performance in a variety of patient subgroups.
  
  
  CONCLUSIONS
  The CONFIRM score permits a significantly improved prediction of mortality over clinical risk scores for >5 years after CCTA. These findings are consistent in a large variety of patient subgroups.
authors.affiliation: Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Deseive
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Department of Radiology, New York Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Department of Medicine, University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico, Monzino, IRCCS Milan, Milano, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
authors.affiliation: Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.affiliation: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.|Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: William Beaumont Hospital, Royal Oaks, MI, USA.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Chinnaiyan
authors.affiliation: Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
authors.affiliation: Baptist Cardiac and Vascular Institute, Miami, FL, USA.
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.affiliation: Capitol Cardiology Associates, Albany, NY, USA.
authors.forename: Augustin
authors.initials: A
authors.lastname: DeLago
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Dunning
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.affiliation: University Hospital, Zurich, Switzerland.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.affiliation: Seoul National University Hospital, Seoul, South Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Hospital da Luz, Lisbon, Portugal.
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.affiliation: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.|Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico, Monzino, IRCCS Milan, Milano, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: William Beaumont Hospital, Royal Oaks, MI, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
authors.affiliation: Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel.
authors.forename: Ronin
authors.initials: R
authors.lastname: Rubinshtein
authors.affiliation: Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.affiliation: Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
authors.affiliation: Division of Radiology, Deutsches Herzzentrum Muenchen, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D038622:Internationality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors
keywords: Cardiac computer tomographic angiography; Coronary Artery Disease; Prognosis