What have we learned from CONFIRM? Prognostic implications from a prospective multicenter international observational cohort study of consecutive patients undergoing coronary computed tomographic angiography Authors
First Online: 12 June 2012 DOI:
Cite this article as: Otaki, Y., Arsanjani, R., Gransar, H. et al. J. Nucl. Cardiol. (2012) 19: 787. doi:10.1007/s12350-012-9582-1 Abstract
Coronary computed tomographic angiography (CCTA) employing CT scanners of 64-detector rows or greater represents a novel non-invasive method for detection of coronary artery disease (CAD), providing excellent diagnostic information when compared to invasive angiography. In addition to its high diagnostic performance, prior studies have shown that CCTA can provide important prognostic information, although these prior studies have been generally limited to small cohorts at single centers. The Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter registry, or CONFIRM, is a large, prospective, multinational, dynamic observational cohort study of patients undergoing CCTA. This registry currently represents more than 32,000 consecutive adults suspected of having CAD who underwent ≥64-detector row CCTA at 12 centers in 6 countries between 2005 and 2009. Based on its large sample size and adequate statistical power, the data derived from CONFIRM registry have and will continue to provide key answers to many important topics regarding CCTA. Based on its multisite international national design, the results derived from CONFIRM should be considered as more generalizable than prior smaller single-center studies. This article summarizes the current status of several studies from CONFIRM registry.
Keywords Prognosis coronary artery disease coronary CT angiography References
Mowatt G, Cook JA, Hillis GS, et al. 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis. Heart 2008;94:1386-93.
Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: Results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008;52:1724-32.
Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359:2324-36.
Meijboom WB, Meijs MFL, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: A prospective, multicenter, multivendor study. J Am Coll Cardiol 2008;52:2135-44.
Pundziute G, Schuijf JD, Jukema JW, et al. Evaluation of plaque characteristics in acute coronary syndromes: Non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis. Eur Heart J 2008;29:2373-81.
Voros S, Rinehart S, Qian Z, et al. Coronary atherosclerosis imaging by coronary CT angiography: Current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging 2011;4:537-48.
Min JK, Shaw LJ, Devereux RB, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 2007;50:1161-70.
Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC. Prognostic value of cardiac computed tomography angiography: A systematic review and meta-analysis. J Am Coll Cardiol 2011;57:1237-47.
Min JK, Dunning A, Lin FY, et al. Rationale and design of the CONFIRM (coronary CT angiography evaluation for clinical outcomes: An International Multicenter) registry. J Cardiovasc Comput Tomogr 2011;5:84-92.
Chaitman BR, Bourassa MG, Davis K, et al. Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS). Circulation 1981;64:360-7.
Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300:1350-8.
Pryor DB, Harrell FE Jr, Lee KL, Califf RM, Rosati RA. Estimating the likelihood of significant coronary artery disease. Am J Med 1983;75:771-80.
Pryor DB, Shaw L, McCants CB, et al. Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med 1993;118:81-90.
Cheng VY, Berman DS, Rozanski A, et al. Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: Results from the multinational Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter registry (CONFIRM). Circulation 2011;124:2423-32.
Akram K, O’Donnell RE, King S, Superko HR, Agatston A, Voros S. Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score. Atherosclerosis 2009;203:533-7.
Cademartiri F, Maffei E, Palumbo A, et al. Diagnostic accuracy of computed tomography coronary angiography in patients with a zero calcium score. Eur Radiol 2010;20:81-7.
Gottlieb I, Miller JM, Arbab-Zadeh A, et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol 2010;55:627-34.
Rubinshtein R, Gaspar T, Halon DA, Goldstein J, Peled N, Lewis BS. Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome. Am J Cardiol 2007;99:472-5.
Villines TC, Hulten EA, Shaw LJ, et al. Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: Results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry. J Am Coll Cardiol 2011;58:2533-40.
Min JK, Dunning A, Lin FY, et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings: Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol 2011;58:849-60.
Diamond GA, Forrester JS, Hirsch M, et al. Application of conditional probability analysis to the clinical diagnosis of coronary artery disease. J Clin Invest 1980;65:1210-21.
Achenbach S, Berman DS, Budoff MJ, et al. Abstract 14099: Prognostic value of coronary CT angiography for the prediction of mortality and non-fatal major adverse cardiac events: Results from the multinational CONFIRM registry. Circulation 2011;124:A14099.
Wilson SR, Lin FY, Dunning AM, et al. Abstract 14999: Prognostic value of plaque composition for the prediction of major adverse cardiovascular events in patients without known coronary artery disease undergoing 64-detector row coronary CT angiography: Results from 6,335 patients in the prospective multinational CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter registry. Circulation 2011;124:A14999.
Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: A scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 2007;30:162-72.
Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-34.
Whiteley L, Padmanabhan S, Hole D, Isles C. Should diabetes be considered a coronary heart disease risk equivalent? Results from 25 years of follow-up in the Renfrew and Paisley survey. Diabetes Care 2005;28:1588-93.
Howard BV, Best LG, Galloway JM, et al. Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors. Diabetes Care 2006;29:391-7.
Grundy SM. Diabetes and coronary risk equivalency: What does it mean? Diabetes Care 2006;29:457-60.
Lin F, Chinnaiyan K, Dunning AM, et al. Gender differences in all-cause death by extent and severity of coronary artery disease by cardiac computed tomographic angiography: A matched analysis of the CONFIRM registry. J Am Coll Cardiol 2011;57:E773.
Hulten E, Villines TC, Dunning AL, et al. Coronary artery disease burden by coronary CT angiography predicts mortality and myocardial infarction across multiple ethnicities: Results from the CONFIRM registry. Circulation 2011;124:A15717.
Otaki Y, LaBounty T, Dunning A, et al. Young patients with a family history of coronary artery disease have higher prevalence, increased severity, and worse prognosis of coronary atherosclerosis: Results from 6308 patients in the prospective multinational CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter registry). J Am Coll Cardiol 2012;59:E1328.
LaBounty TM, Achenbach S, Al-Mallah M, et al. Hypertensive individuals have an increased prevalence of coronary artery disease and risk of adverse events: A comparison of 15,091 individuals from CONFIRM (coronary Computed Tomographic Angiography Evaluation for Clinical Outcomes: An International Multicenter registry). J Am Coll Cardiol 2012;59:E1371.
Chow BJW, Wells GA, Chen L, et al. Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol 2010;55:1017-28.
Chow BJW, Small G, Yam Y, et al. Incremental prognostic value of cardiac computed tomography in coronary artery disease using CONFIRM: Coronary Computed Tomography Angiography Evaluation For Clinical Outcomes: An International Multicenter registry. Circ Cardiovasc Imaging 2011;4:463-72.
Arsanjani R, LaBounty T, Gransar H, et al. Degree of left ventricular systolic dysfunction by cardiac computed tomographic angiography improves risk stratification and discrimination of patients at risk for incident mortality: Results from 7907 patients in the prospective multicenter international CONFIRM study. J Am Coll Cardiol 2012;59:E1329.
Small GR, Yam Y, Chen L, et al. Prognostic assessment of coronary artery bypass patients with 64-slice computed tomography angiography: Anatomical information is incremental to clinical risk prediction. J Am Coll Cardiol 2011;58:2389-95.
PubMed CrossRef Copyright information
© American Society of Nuclear Cardiology 2012