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])
- Authors
- Han, Donghee; Beecy, Ashley; Anchouche, Khalil; Gransar, Heidi; Dunham, Patricia C.; Lee, Ji-Hyun; Achenbach, Stephan; Al-Mallah, Mouaz H.; Andreini, Daniele; Lin, Fay Y.
- Issue Date
- Nov-2019
- Publisher
- EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
- Citation
- AMERICAN JOURNAL OF CARDIOLOGY, v.124, no.9, pp.1397 - 1405
- Indexed
- SCIE
SCOPUS
- Journal Title
- AMERICAN JOURNAL OF CARDIOLOGY
- Volume
- 124
- Number
- 9
- Start Page
- 1397
- End Page
- 1405
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/190233
- DOI
- 10.1016/j.amjcard.2019.07.045
- ISSN
- 0002-9149
- 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.
- Files in This Item
-
Go to Link
- Appears in
Collections - 서울 의과대학 > 서울 교육협력지원교실 > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.