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Han, Donghee; Beecy, Ashley; Anchouche, Khalil; Gransar, Heidi; Dunham, Patricia C.; Lee, Ji-Hyun; Achenbach, Stephan; Al-Mallah, Mouaz H.; Andreini, Daniele; Berman, Daniel S.; Bax, Jeroen J.; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J. W.; Cury, Ricardo C.; DeLago, Augustin; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jörg; Kaufmann, Philipp A.; Kim, Yong-Jin; Leipsic, Jonathon A.; Maffei, Erica; Marques, Hugo; Goncalves, Pedro de Araujo; Pontone, Gianluca; Raff, Gilbert L.; Rubinshtein, Ronen; Villines, Todd C.; Lu, Yao; Pena, Jessica M.; Shaw, Leslee J.; Min, James K. and Lin, Fay Y. (2019): Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM]). In: American Journal of Cardiology, Vol. 124, No. 9: pp. 1397-1405

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Abstract

The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p > 0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA. (C) 2019 Published by Elsevier Inc.

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