Deseive Simon, Shaw Leslee J, Min James K, Achenbach Stephan, Andreini Daniele, Al-Mallah Mouaz H, Berman Daniel S, Budoff Matthew J, Callister Tracy Q, Cademartiri Filippo, Chang Hyuk-Jae, Chinnaiyan Kavitha, Chow Benjamin J W, Cury Ricardo C, DeLago Augustin, Dunning Allison M, Feuchtner Gudrun, Kaufmann Philipp A, Kim Yong-Jin, Leipsic Jonathon, Marques Hugo, Maffei Erica, Pontone Gianluca, Raff Gilbert, Rubinshtein Ronin, Villines Todd C, Hausleiter Jörg, Hadamitzky Martin
Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Eur Heart J Cardiovasc Imaging. 2017 Mar 1;18(3):286-293. doi: 10.1093/ehjci/jew195.
To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA).
Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality. The predictive value of the CONFIRM score over clinical risk scores (Morise, Framingham, and NCEP ATP III score) was studied in the entire patient population as well as in subgroups. Improvement in risk prediction and patient reclassification were assessed using categorical net reclassification index (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 5.3 years, 982 (6.5%) of 15 219 patients died. The CONFIRM score outperformed the prognostic value of the studied three clinical risk scores (c-indices: CONFIRM score 0.696, NCEP ATP III score 0.675, Framingham score 0.610, Morise score 0.606; c-index for improvement CONFIRM score vs. NCEP ATP III score 0.650, P < 0.0001). Application of the CONFIRM score allowed reclassification of 34% of patients when compared with the NCEP ATP III score, which was the best clinical risk score. Reclassification was significant as revealed by categorical NRI (0.06 with 95% CI 0.02 and 0.10, P = 0.005) and IDI (0.013 with 95% CI 0.01 and 0.015, P < 0.001). Subgroup analysis revealed a comparable performance in a variety of patient subgroups.
The CONFIRM score permits a significantly improved prediction of mortality over clinical risk scores for >5 years after CCTA. These findings are consistent in a large variety of patient subgroups.
在接受冠状动脉计算机断层扫描血管造影（CCTA）的大型患者队列中，研究CONFIRM评分对全因死亡率的长期预测性能。
纳入国际多中心CONFIRM注册研究中随访5年的患者。主要终点为全因死亡率。在整个患者群体以及亚组中研究了CONFIRM评分相对于临床风险评分（莫里塞评分、弗雷明汉评分和美国国家胆固醇教育计划成人治疗组第三次报告（NCEP ATP III）评分）的预测价值。使用分类净重新分类指数（NRI）和综合判别改善（IDI）评估风险预测的改善情况和患者重新分类情况。在中位随访期5.3年期间，15219例患者中有982例（6.5%）死亡。CONFIRM评分的预后价值优于所研究的三个临床风险评分（c指数：CONFIRM评分为0.696，NCEP ATP III评分为0.675，弗雷明汉评分为0.610，莫里塞评分为0.606；CONFIRM评分与NCEP ATP III评分相比改善的c指数为0.650，P<0.0001）。与最佳临床风险评分NCEP ATP III评分相比，应用CONFIRM评分可使34%的患者重新分类。分类NRI（0.06，95%CI为0.02至0.10，P=0.005）和IDI（0.013，95%CI为0.01至0.015，P<0.001）显示重新分类具有显著性。亚组分析显示在各种患者亚组中具有相似的性能。
CONFIRM评分在CCTA后5年以上对死亡率的预测明显优于临床风险评分。这些发现在各种患者亚组中是一致的。
