Ayoub Chadi, Kritharides Leonard, Yam Yeung, Chen Li, Hossain Alomgir, Achenbach Stephan, Al-Mallah Mouaz H, Andreini Daniele, Berman Daniel S, Budoff Matthew J, Cademartiri Filippo, Callister Tracy Q, Chang Hyuk-Jae, Chinnaiyan Kavitha, Cury Ricardo C, Delago Augustin, Dunning Allison, Feuchtner Gudrun, Gomez Millie, Gransar Heidi, Hadamitzky Martin, Hausleiter Joerg, Hindoyan Niree, Kaufmann Philipp A, Kim Yong-Jin, Leipsic Jonathon, Maffei Erica, Marques Hugo, Pontone Gianluca, Raff Gilbert, Rubinshtein Ronen, Shaw Leslee J, Villines Todd C, Min James K, Chow Benjamin J W
Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
Heart Vessels. 2018 Nov;33(11):1288-1300. doi: 10.1007/s00380-018-1188-3. Epub 2018 May 24.
Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of 'age adjusted SIS' (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7 years, 55.8% male) with a median follow-up of 27.3 months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83-3.16, p < 0.001), C-statistic 0.723 (0.700-0.756), net reclassification improvement (NRI) 0.36 (0.26-0.47, p < 0.001), and relative integrated discrimination improvement (IDI) 0.33 (p = 0.009). aSIS had HR 3.48 (2.33-5.18, p < 0.001) for mortality in those without obstructive CAD, compared to HR 1.79 (1.25-2.58, p = 0.02) in those with obstructive CAD. In conclusion, aSIS has an incremental prognostic value to traditional risk factors and obstructive CAD, and may enhance CCTA risk stratification.
通过节段累及评分（SIS）测量的冠状动脉计算机断层扫描血管造影（CCTA）上冠状动脉粥样硬化疾病（CAD）负担程度具有预后价值。我们试图研究“年龄调整后的SIS”（aSIS）的增量预后价值，其可能是早期动脉粥样硬化和血管年龄的一个标志物。连续患者被前瞻性纳入CONFIRM（冠状动脉CT血管造影临床结果评估：一项国际多中心研究）多国观察性研究。对患者进行全因死亡结局随访。为每位患者在CCTA上计算aSIS，并评估其增量预后价值。共确定了22211例患者[平均年龄58.5±12.7岁，55.8%为男性]，中位随访时间为27.3个月（四分位间距17.8，35.4）。在调整临床因素和阻塞性CAD的存在后，多变量分析显示较高的aSIS与死亡风险增加相关，风险比（HR）为2.40（1.83 - 3.16，p < 0.001），C统计量为0.723（0.700 - 0.756），净重新分类改善（NRI）为0.36（0.26 - 0.47，p < 0.001），相对综合鉴别改善（IDI）为0.33（p = 0.009）。对于无阻塞性CAD的患者，aSIS的死亡HR为3.48（2.33 - 5.18，p < 0.001），而对于有阻塞性CAD的患者，HR为1.79（
