Erica Maffei MD, Presenter: Nothing to Disclose

Sara Seitun MD, Abstract Co-Author: Nothing to Disclose

Filippo Cademartiri MD, PhD, Abstract Co-Author: Speakers Bureau, Bracco Group Research grant, General Electric Company

Hyuk-Jae Chang, Abstract Co-Author: Nothing to Disclose

Allison Dunning, Abstract Co-Author: Nothing to Disclose

Fay Lin, Abstract Co-Author: Nothing to Disclose

Millie Gomez, Abstract Co-Author: Nothing to Disclose

Stephan Achenbach MD, Abstract Co-Author: Speakers Bureau, Siemens AG Consultant, SERVIER Research grant, Siemens AG Research grant, Bayer AG

Mouaz Al-Mallah, Abstract Co-Author: Nothing to Disclose

Daniel S. Berman MD, Abstract Co-Author: Research grant, Lantheus Medical Imaging, Inc Research grant, Astellas Group Research grant, Siemens AG Speaker, Bristol-Myers Squibb Company Speaker, Covidien AG Speaker, Astellas Group Stockholder, Spectrum Dynamics Ltd Consultant, Bracco Group Consultant, FlouroPharma, Inc

Matthew J. Budoff MD, Abstract Co-Author: Speakers Bureau, General Electric Company

Tracy Q Callister MD, Abstract Co-Author: Speakers Bureau, General Electric Company Research support, General Electric Company

Victor Y Cheng, Abstract Co-Author: Nothing to Disclose

Benjamin Chow MD, Abstract Co-Author: Nothing to Disclose

Augustin Delago, Abstract Co-Author: Nothing to Disclose

Martin Hadamitzky, Abstract Co-Author: Nothing to Disclose

Jörg Hausleiter MD, Abstract Co-Author: Nothing to Disclose

Philipp A. Kaufmann MD, Abstract Co-Author: Nothing to Disclose

Khurram Nasir, Abstract Co-Author: Nothing to Disclose

Leslee Shaw PhD, Abstract Co-Author: Grant, Bracco Group Grant, Astellas Group

Gilbert Raff MD, Abstract Co-Author: Nothing to Disclose

Todd C Villines, Abstract Co-Author: Nothing to Disclose

Kavitha M Chinnaiyan, Abstract Co-Author: Nothing to Disclose

James K. Min, Abstract Co-Author: Speakers Bureau, General Electric Company Medical Advisory Board, General Electric Company

To examine the association of all-cause mortality with the computed tomography coronary angiography (CTCA) evidence of coronary artery disease (CAD), with focus on the presence and severity of left main (LM) disease.

A total of 7700 patients (4120 men, age 57.5±11.9 years) without known history of CAD from an International multicenter CTCA registry (CONFIRM Registry) met the inclusion criteria (total database 27125 patients). A 12 coronary artery segments analysis was performed. Cox proportional hazard models with adjustment for risk factors and after stratification according to LM disease were developed to predict outcome.

The majority of patients (85.2%, n=6559) were at low-to-intermediate risk of CAD according to Framingham risk. The prevalence of obstructive (>50%) CAD was 14.7% (n=1135), whereas 33% (n=2538) of patients had non-obstructive CAD and 52.3% (n=4027) had normal coronary arteries. The presence of obstructive (>50%) and non-obstructive CAD in LM were respectively 0.9% (n=69) and 11% (n=845). A total of 95/7700 deaths (1.2%) occurred after a mean follow-up of 29±14 months. Severity and extension of CAD was associated with a progressively worse prognosis (p<0.0001). Patients who died compared with those who survived had a higher prevalence of obstructive disease (n=35, 36.8% vs. n=1100, 14.5%, p<0.0001), a higher number of overall diseased segments (3.1±3.0 vs. 1.58±2.4, p<0.0001) and of segments with non-obstructive CAD (2.4±2.5 vs. 1.27±1.98, p<0.0001). Multivariate analysis showed that CAD severity (HR:3.3; 95%CI:1.8-5.9, p<0.0001) and the number of diseased segments (HR:1.13; 95%CI:1.05-1.22, p=0.002) were predictors of all-cause mortality with incremental prognostic value over Framingham risk and calcium score. Risk-adjusted survival showed that the presence of either non-obstructive or obstructive (cut-off >50%) LM disease was not associated with a significantly worse prognosis. However, after considering a cut-off value >70% for obstructive CAD, patients with LM disease fared the worst (p<0.0001).

CTCA is an emerging tool used for risk stratification and appears to be promising in the prediction of all-cause mortality. LM disease presence and severity seems to be poorly associated with worse prognosis.

CTCA appears to be a clinically useful imaging method for risk stratification. Severe (>70%) narrowing of the LM has the worse prognosis.

Maffei, E, Seitun, S, Cademartiri, F, Chang, H, Dunning, A, Lin, F, Gomez, M, Achenbach, S, Al-Mallah, M, Berman, D, Budoff, M, Callister, T, Cheng, V, Chow, B, Delago, A, Hadamitzky, M, Hausleiter, J, Kaufmann, P, Nasir, K, Shaw, L, Raff, G, Villines, T, Chinnaiyan, K, Min, J, Prognostic Value of CT Coronary Angiography: Focus on Severity of Coronary Disease and on Left Main Involvement&#8212Results from the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010336.html