Bruce Precious MD, Presenter: Nothing to Disclose

Philipp Blanke MD, Abstract Co-Author: Nothing to Disclose

Sasi Rekha Ganga Raju, Abstract Co-Author: Nothing to Disclose

Iksung Cho, Abstract Co-Author: Nothing to Disclose

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

Jonathon Avrom Leipsic MD, Abstract Co-Author: Speakers Bureau, General Electric Company Speakers Bureau, Edwards Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc

Fay Lin, Abstract Co-Author: Nothing to Disclose

Stephan Achenbach MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Bayer AG Research Grant, Abbott Laboratories Speaker, Guerbet SA Speaker, Siemens AG Speaker, Bayer AG Speaker, AstraZeneca PLC Speaker, Berlin-Chemie AG Speaker, Abbott Laboratories Speaker, Edwards Lifesciences Corporation

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: Research Consultant, General Electric Company

Tracy Q. Callister MD, Abstract Co-Author: Nothing to Disclose

Mouaz Al-Mallah, Abstract Co-Author: Consultant, General Electric Company

Filippo Cademartiri MD, PhD, Abstract Co-Author: Speakers Bureau, Bracco Group Consultant, Guerbet SA Speakers Bureau, Guerbet SA

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

Benjamin Chow MD, Abstract Co-Author: Research Grant, General Electric Company Support, TeraRecon, Inc

Allison Dunning, Abstract Co-Author: Nothing to Disclose

Augustin Delago, Abstract Co-Author: Nothing to Disclose

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

Martin Hadamitzky, Abstract Co-Author: Nothing to Disclose

Jorg Hausleiter, Abstract Co-Author: Nothing to Disclose

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

Philipp A. Kaufmann MD, Abstract Co-Author: Researcher, General Electric Company

Ricardo Caldeira Cury MD, Abstract Co-Author: Research Grant, Astellas Group Research Consultant, Astellas Group Research Grant, General Electric Company Research Consultant, General Electric Company Research Consultant, Novartis AG Research Consultant, Heartflow, Inc

Gudrun Feuchtner MD, Abstract Co-Author: Nothing to Disclose

Yong-Jin Kim, Abstract Co-Author: Nothing to Disclose

Erica Maffei MD, Abstract Co-Author: Nothing to Disclose

Gilbert Raff MD, Abstract Co-Author: Research Grant, Siemens AG

Gianluca Pontone MD, Abstract Co-Author: Speakers Bureau, General Electric Company Consultant, General Electric Company Research Consultant, HeartFlow, Inc Speakers Bureau, HeartFlow, Inc Speakers Bureau, Medtronic, Inc Speakers Bureau, Bayer AG

Daniele Andreini MD, Abstract Co-Author: Consultant, General Electric Company

Hugo Miguel Rodrigues Marques MD, Abstract Co-Author: Nothing to Disclose

Ronen Rubinshtein MD, Abstract Co-Author: Fellowship funded, Koninklijke Philips NV

Millie Gomez, Abstract Co-Author: Nothing to Disclose

James K. Min, Abstract Co-Author: Speakers Bureau, General Electric Company Advisory Board, General Electric Company Stockholder, General Electric Company Consultant, Koninklijke Philips NV

While the short term prognostic value of coronary artery disease (CAD) findings by coronary computed tomographic angiography (CCTA) is well established, the long term prognostic utility of CCTA for low risk patients with no modifiable CAD risk factors is not known.

From 16 centers, 1295 low risk patients undergoing CCTA without prior CAD or any modifiable CAD risk factors were identified. CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (> 50% stenosis severity). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to all cause death was the primary endpoint, with a subgroup of 670 patients who were evaluated for major adverse cardiovascular event (MACE)—defined as death, myocardial infarction, unstable angina, or late coronary revascularization— and both endpoints were analyzed using multivariable Cox proportional hazards models.

At a 5.6±1.3-year follow-up, 113 (8.7%) deaths and in the MACE subgroup 116 events(14.8%) occurred. In age and gender-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 5.6; 95% confidence interval [CI]: 3.1-10.3; p<0.001) and non-obstructive (HR: 2.2; 95% CI: 1.2-3.8; p=0.01) CAD were related to MACE. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for non-obstructive (HR: 1.6; 95% CI: 1.0-2.6; p=0.07), obstructive 1-vessel (HR: 1.8; 95% CI:1.04-3.2; p=0.04), 2-vessel (HR: 1.6; 95% CI: 0.8-3.5; p=0.20), or 3-vessel or left main (HR: 3.1; 95% CI:1.6-6.1; p=0.001) CAD. The relative risk for death associated with non-obstructive disease was similar to single vessel obstructive disease (p=0.22).

Among low risk individuals without modifiable risk factors CCTA findings convey important long term prognostic information with a dose response relationship for both mortality and MACE. Interestingly, non-obstructive disease by CCTA conveys a similar mortality risk as single vessel obstructive disease at 5 years. 

Coronary computed tomographic angiography in low risk individuals can be used for long term prognostication with respect to mortality and major adverse cardiovascular events.

Precious, B, Blanke, P, Ganga Raju, S, Cho, I, Chang, H, Leipsic, J, Lin, F, Achenbach, S, Berman, D, Budoff, M, Callister, T, Al-Mallah, M, Cademartiri, F, Chinnaiyan, K, Chow, B, Dunning, A, Delago, A, Villines, T, Hadamitzky, M, Hausleiter, J, Shaw, L, Kaufmann, P, Cury, R, Feuchtner, G, Kim, Y, Maffei, E, Raff, G, Pontone, G, Andreini, D, Marques, H, Rubinshtein, R, Gomez, M, Min, J, Long Term Prognostic Utility of Coronary CT Angiography in Low Risk Patients with No Modifiable Coronary Artery Disease Risk Factors: Results from the CONFIRM International Multicenter Registry.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011397.html