Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
Eur Heart J Cardiovasc Imaging. 2019 Nov 1;20(11):1279-1286. doi: 10.1093/ehjci/jez067.
The long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations.
From the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age <70 years (n = 7198) vs. ≥70 years (n = 1786). The severity of CAD was classified according to: (i) maximal stenosis degree per vessel: none, non-obstructive (1-49%), or obstructive (>50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both <70 years [non-obstructive hazard ratio (HR) confidence interval (CI): 1.70 (1.19-2.41); one-vessel: 1.65 (1.03-2.67); two-vessel: 2.24 (1.21-4.15); three-vessel/left main: 4.12 (2.27-7.46), P < 0.001] and ≥70 years [non-obstructive: 1.84 (1.15-2.95); one-vessel: HR (CI): 2.28 (1.37-3.81); two-vessel: 2.36 (1.33-4.19); three-vessel/left main: 2.41 (1.33-4.36), P = 0.014]. Similarly, SIS was predictive of mortality in both <70 years [SIS 1-3: 1.57 (1.10-2.24); SIS ≥4: 2.42 (1.65-3.57), P < 0.001] and ≥70 years [SIS 1-3: 1.73 (1.07-2.79); SIS ≥4: 2.45 (1.52-3.93), P < 0.001]. CCTA findings similarly predicted long-term major adverse cardiovascular outcomes (MACE) (all-cause mortality, myocardial infarction, and late revascularization) in both groups compared with patients with no CAD.
The presence and extent of CAD is a meaningful stratifier of long-term mortality and MACE in patients aged <70 years and ≥70 years old. The presence of obstructive and non-obstructive disease and the burden of atherosclerosis determined by SIS remain important predictors of prognosis in older populations.
冠状动脉计算机断层血管造影术（CCTA）诊断的冠状动脉疾病（CAD）的长期预后价值尚未在老年患者（≥70 岁）中进行评估。我们比较了冠状动脉 CCTA 在预测 5 年死亡率方面在老年患者与年轻患者中的作用。
从前瞻性 CONFIRM（冠状动脉 CT 血管造影评估用于临床结果：国际多中心）登记处，我们根据年龄<70 岁（n=7198）和≥70 岁（n=1786）分析了 CCTA 结果。CAD 的严重程度根据：（i）每支血管的最大狭窄程度：无狭窄、非阻塞性（1-49%）或阻塞性（>50%）；（ii）节段受累评分（SIS）：斑块所在节段数。Cox 比例风险模型评估了 CCTA 结果与死亡率之间的关系。在平均 5.6±1.1 年的随访中，与正常 CCTA 相比，CCTA 诊断的 CAD 在<70 岁的患者中预示着死亡率增加[非阻塞性危险比（HR）置信区间（CI）：1.70（1.19-2.41）；单支血管：1.65（1.03-2.67）；两支血管：2.24（1.21-4.15）；三支血管/左主干：4.12（2.27-7.46），P<0.001]和≥70 岁的患者中也预示着死亡率增加[非阻塞性：1.84（1.15-2.95）；单支血管：HR（CI）：2.28（1.37-3.81）；两支血管：2.36（1.33-4.19）；三支血管/左主干：2.41（1.33-4.36），P=0.014]。同样，SIS 也可预测<70 岁患者的死亡率[SIS 1-3：1.57（1.10-2.24）；SIS≥4：2.42（1.65-3.57），P<0.001]和≥70 岁患者的死亡率[SIS 1-3：1.73（1.07-2.79）；SIS≥4：2.45（1.52-3.93），P<0.001]。与无 CAD 患者相比，CCTA 结果在两组患者中也同样预测了长期主要不良心血管事件（MACE）（全因死亡率、心肌梗死和晚期血运重建）。
CAD 的存在和严重程度是<70 岁和≥70 岁患者长期死亡率和 MACE 的重要分层因素。SIS 确定的阻塞性和非阻塞性疾病以及动脉粥样硬化负担仍然是老年人群预后的重要预测因素。
