Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography

a Danish multicentre cohort study

Lene Hüche Nielsen, Hans Erik Bøtker, Henrik T. Sørensen, Morten Schmidt, Lars Pedersen, Niels Peter Sand, Jesper M Jensen, Flemming Hald Steffensen, Hans Henrik Tilsted, Morten Bøttcher, Axel Diederichsen, Jess Lambrechtsen, Lone Deibjerg Kristensen, Kristian Altern Øvrehus, Hans Mickley, Henrik Munkholm, Ole Goetzsche, Majed Husain, Lars Knudsen, Bjarne L Nørgaard

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity.

Methods and results: This cohort study included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death. The Kaplan-Meier estimator was used to compute 91 day to 3.5 year risk according to the CAD severity. Comparisons between patients with and without CAD were based on Cox-regression adjusted for age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac medications, and post-CCTA treatment within 90 days. The composite endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5% for patients without CAD, 6.8% for obstructive CAD, and 15% for three-vessel/left main disease. Compared with patients without CAD, higher relative risk of the composite endpoint was observed for non-obstructive CAD [hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.01-1.63], obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95% CI :2.90-6.69). The results were consistent in strata of age, sex, and comorbidity.

Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.

Original languageEnglish
JournalEuropean Heart Journal
Volume38
Issue number6
Pages (from-to)413-421
ISSN0195-668X
DOIs
Publication statusPublished - 7. Feb 2017

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Multicenter Studies
Coronary Artery Disease
Cohort Studies
Comorbidity
Confidence Intervals
Computed Tomography Angiography
Cause of Death
Age Groups

Keywords

  • Journal Article

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Hüche Nielsen, Lene ; Bøtker, Hans Erik ; Sørensen, Henrik T. ; Schmidt, Morten ; Pedersen, Lars ; Sand, Niels Peter ; Jensen, Jesper M ; Hald Steffensen, Flemming ; Tilsted, Hans Henrik ; Bøttcher, Morten ; Diederichsen, Axel ; Lambrechtsen, Jess ; Kristensen, Lone Deibjerg ; Øvrehus, Kristian Altern ; Mickley, Hans ; Munkholm, Henrik ; Goetzsche, Ole ; Husain, Majed ; Knudsen, Lars ; Nørgaard, Bjarne L. / Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography : a Danish multicentre cohort study. In: European Heart Journal. 2017 ; Vol. 38, No. 6. pp. 413-421.
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abstract = "Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity.Methods and results: This cohort study included 16,949 patients (median age 57 years; 57{\%} women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death. The Kaplan-Meier estimator was used to compute 91 day to 3.5 year risk according to the CAD severity. Comparisons between patients with and without CAD were based on Cox-regression adjusted for age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac medications, and post-CCTA treatment within 90 days. The composite endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5{\%} for patients without CAD, 6.8{\%} for obstructive CAD, and 15{\%} for three-vessel/left main disease. Compared with patients without CAD, higher relative risk of the composite endpoint was observed for non-obstructive CAD [hazard ratio (HR): 1.28; 95{\%} confidence interval (CI): 1.01-1.63], obstructive one-vessel CAD (HR: 1.83; 95{\%} CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95{\%} CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95{\%} CI :2.90-6.69). The results were consistent in strata of age, sex, and comorbidity.Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.",
keywords = "Journal Article",
author = "{H{\"u}che Nielsen}, Lene and B{\o}tker, {Hans Erik} and S{\o}rensen, {Henrik T.} and Morten Schmidt and Lars Pedersen and Sand, {Niels Peter} and Jensen, {Jesper M} and {Hald Steffensen}, Flemming and Tilsted, {Hans Henrik} and Morten B{\o}ttcher and Axel Diederichsen and Jess Lambrechtsen and Kristensen, {Lone Deibjerg} and {\O}vrehus, {Kristian Altern} and Hans Mickley and Henrik Munkholm and Ole Goetzsche and Majed Husain and Lars Knudsen and N{\o}rgaard, {Bjarne L}",
year = "2017",
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Hüche Nielsen, L, Bøtker, HE, Sørensen, HT, Schmidt, M, Pedersen, L, Sand, NP, Jensen, JM, Hald Steffensen, F, Tilsted, HH, Bøttcher, M, Diederichsen, A, Lambrechtsen, J, Kristensen, LD, Øvrehus, KA, Mickley, H, Munkholm, H, Goetzsche, O, Husain, M, Knudsen, L & Nørgaard, BL 2017, 'Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study', European Heart Journal, vol. 38, no. 6, pp. 413-421. https://doi.org/10.1093/eurheartj/ehw548

Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography : a Danish multicentre cohort study. / Hüche Nielsen, Lene; Bøtker, Hans Erik; Sørensen, Henrik T.; Schmidt, Morten; Pedersen, Lars; Sand, Niels Peter; Jensen, Jesper M; Hald Steffensen, Flemming; Tilsted, Hans Henrik; Bøttcher, Morten; Diederichsen, Axel; Lambrechtsen, Jess; Kristensen, Lone Deibjerg; Øvrehus, Kristian Altern; Mickley, Hans; Munkholm, Henrik; Goetzsche, Ole; Husain, Majed; Knudsen, Lars; Nørgaard, Bjarne L.

In: European Heart Journal, Vol. 38, No. 6, 07.02.2017, p. 413-421.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography

T2 - a Danish multicentre cohort study

AU - Hüche Nielsen, Lene

AU - Bøtker, Hans Erik

AU - Sørensen, Henrik T.

AU - Schmidt, Morten

AU - Pedersen, Lars

AU - Sand, Niels Peter

AU - Jensen, Jesper M

AU - Hald Steffensen, Flemming

AU - Tilsted, Hans Henrik

AU - Bøttcher, Morten

AU - Diederichsen, Axel

AU - Lambrechtsen, Jess

AU - Kristensen, Lone Deibjerg

AU - Øvrehus, Kristian Altern

AU - Mickley, Hans

AU - Munkholm, Henrik

AU - Goetzsche, Ole

AU - Husain, Majed

AU - Knudsen, Lars

AU - Nørgaard, Bjarne L

PY - 2017/2/7

Y1 - 2017/2/7

N2 - Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity.Methods and results: This cohort study included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death. The Kaplan-Meier estimator was used to compute 91 day to 3.5 year risk according to the CAD severity. Comparisons between patients with and without CAD were based on Cox-regression adjusted for age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac medications, and post-CCTA treatment within 90 days. The composite endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5% for patients without CAD, 6.8% for obstructive CAD, and 15% for three-vessel/left main disease. Compared with patients without CAD, higher relative risk of the composite endpoint was observed for non-obstructive CAD [hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.01-1.63], obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95% CI :2.90-6.69). The results were consistent in strata of age, sex, and comorbidity.Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.

AB - Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity.Methods and results: This cohort study included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death. The Kaplan-Meier estimator was used to compute 91 day to 3.5 year risk according to the CAD severity. Comparisons between patients with and without CAD were based on Cox-regression adjusted for age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac medications, and post-CCTA treatment within 90 days. The composite endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5% for patients without CAD, 6.8% for obstructive CAD, and 15% for three-vessel/left main disease. Compared with patients without CAD, higher relative risk of the composite endpoint was observed for non-obstructive CAD [hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.01-1.63], obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95% CI :2.90-6.69). The results were consistent in strata of age, sex, and comorbidity.Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.

KW - Journal Article

U2 - 10.1093/eurheartj/ehw548

DO - 10.1093/eurheartj/ehw548

M3 - Journal article

VL - 38

SP - 413

EP - 421

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 6

ER -