Skip to main content

Advertisement

SpringerLink
Log in

Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P, Rubin GD, American College of Cardiology Foundation Appropriate Use Criteria Task F, Society of Cardiovascular Computed T, American College of R, American Heart A, American Society of E, American Society of Nuclear C, North American Society for Cardiovascular I, Society for Cardiovascular A, Interventions, Society for Cardiovascular Magnetic R (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 4(6):407 e1–407 e33

    Google Scholar 

  2. Chow BJ, Wells GA, Chen L, Yam Y, Galiwango P, Abraham A, Sheth T, Dennie C, Beanlands RS, Ruddy TD (2010) Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol 55(10):1017–1028

    Article  Google Scholar 

  3. Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ, Lippolis NJ, Berman DS, Callister TQ (2007) Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 50(12):1161–1170

    Article  Google Scholar 

  4. Lin FY, Shaw LJ, Dunning AM, Labounty TM, Choi JH, Weinsaft JW, Koduru S, Gomez MJ, Delago AJ, Callister TQ, Berman DS, Min JK (2011) Mortality risk in symptomatic patients with nonobstructive coronary artery disease: a prospective 2-center study of 2,583 patients undergoing 64-detector row coronary computed tomographic angiography. J Am Coll Cardiol 58(5):510–519

    Article  Google Scholar 

  5. Bittencourt MS, Hulten E, Ghoshhajra B, O’Leary D, Christman MP, Montana P, Truong QA, Steigner M, Murthy VL, Rybicki FJ, Nasir K, Gowdak LH, Hainer J, Brady TJ, Di Carli MF, Hoffmann U, Abbara S, Blankstein R (2014) Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging 7(2):282–291

    Article  Google Scholar 

  6. Hadamitzky M, Distler R, Meyer T, Hein F, Kastrati A, Martinoff S, Schomig A, Hausleiter J (2011) Prognostic value of coronary computed tomographic angiography in comparison with calcium scoring and clinical risk scores. Circ Cardiovasc Imaging 4(1):16–23

    Article  Google Scholar 

  7. Ayoub C, Erthal F, Abdelsalam MA, Murad MH, Wang Z, Erwin PJ, Hillis GS, Kritharides L, Chow BJW (2017) Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography: a systematic review and meta-analysis. J Cardiovasc Comput Tomogr 11(4):258–267

    Article  Google Scholar 

  8. Raggi P, Callister TQ, Shaw LJ (2004) Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy. Arterioscler Thromb Vasc Biol 24(7):1272–1277

    Article  CAS  Google Scholar 

  9. Waters D, Craven TE, Lesperance J (1993) Prognostic significance of progression of coronary atherosclerosis. Circulation 87(4):1067–1075

    Article  CAS  Google Scholar 

  10. Nicholls SJ, Hsu A, Wolski K, Hu B, Bayturan O, Lavoie A, Uno K, Tuzcu EM, Nissen SE (2010) Intravascular ultrasound-derived measures of coronary atherosclerotic plaque burden and clinical outcome. J Am Coll Cardiol 55(21):2399–2407

    Article  Google Scholar 

  11. Ayoub C, Yam Y, Chen L, Arasaratnam P, Chow CK, Hillis GS, Kritharides L, Chow BJ (2016) The prognostic value of percentage total plaque score adjusted to age: a potential marker of coronary vascular age. Angiology 7(10):916–926

    Article  Google Scholar 

  12. Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah MH, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, Chinnaiyan KM, Chow B, Delago A, Hadamitzky M, Hausleiter J, Karlsberg RP, Kaufmann P, Maffei E, Nasir K, Pencina MJ, Raff GL, Shaw LJ, Villines TC (2011) Rationale and design of the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: an InteRnational Multicenter) Registry. J Cardiovasc Comput Tomogr 5(2):84–92

    Article  Google Scholar 

  13. National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults Adult Treatment Panel III (2002) Detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106(25):3143–3421

    Article  Google Scholar 

  14. Chaitman BR, Bourassa MG, Davis K, Rogers WJ, Tyras DH, Berger R, Kennedy JW, Fisher L, Judkins MP, Mock MB, Killip T (1981) Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS). Circulation 64(2):360–367

    Article  CAS  Google Scholar 

  15. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, Grunwald MA, Levy D, Lytle BW, O’Rourke RA, Schafer WP, Williams SV, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Russell RO, Ryan TJ, Smith SC Jr (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 33(7):2092–2197

    Article  CAS  Google Scholar 

  16. Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GJ, Nieman K, Pontone G, Raff GL (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8(5):342–358

    Article  Google Scholar 

  17. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15(4):827–832

    Article  CAS  Google Scholar 

  18. Pencina MJ, D’Agostino RB (2004) Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med 23(13):2109–2123

    Article  Google Scholar 

  19. Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27(2):157–172 (discussion 207–212)

    Article  Google Scholar 

  20. Pencina MJ, D’Agostino RB Sr, Steyerberg EW (2011) Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med 30(1):11–21

    Article  Google Scholar 

  21. Pen A, Yam Y, Chen L, Dennie C, McPherson R, Chow BJ (2013) Discordance between Framingham Risk Score and atherosclerotic plaque burden. Eur Heart J 34(14):1075–1082

    Article  CAS  Google Scholar 

  22. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, Parise H, Templin B, White R, Zhang Z, Serruys PW, Investigators P (2011) A prospective natural-history study of coronary atherosclerosis. N Engl J Med 364(3):226–235

    Article  CAS  Google Scholar 

  23. Burke AP, Kolodgie FD, Farb A, Weber DK, Malcom GT, Smialek J, Virmani R (2001) Healed plaque ruptures and sudden coronary death: evidence that subclinical rupture has a role in plaque progression. Circulation 103(7):934–940

    Article  CAS  Google Scholar 

  24. Proudfit WL, Bruschke VG, Sones FM Jr (1980) Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10-year follow-up of 521 patients. Circulation 62(4):712–717

    Article  CAS  Google Scholar 

  25. Choi TY, Li D, Nasir K, Zeb I, Sourayanezhad S, Gupta M, Hacioglu Y, Mao SS, Budoff MJ (2013) Differences in coronary atherosclerotic plaque burden and composition according to increasing age on computed tomography angiography. Acad Radiol 20(2):202–208

    Article  Google Scholar 

  26. Tota-Maharaj R, Blaha MJ, Rivera JJ, Henry TS, Choi EK, Chang SA, Yoon YE, Chun EJ, Choi SI, Blumenthal RS, Chang HJ, Nasir K (2012) Differences in coronary plaque composition with aging measured by coronary computed tomography angiography. Int J Cardiol 158(2):240–245

    Article  Google Scholar 

  27. Enos WF, Holmes RH, Beyer J (1986) Landmark article, July 18, 1953: coronary disease among United States soldiers killed in action in Korea. Preliminary report. By William F. Enos, Robert H. Holmes and James Beyer. JAMA 256(20):2859–2862

    Article  CAS  Google Scholar 

  28. Kaski JC, Chester MR, Chen L, Katritsis D (1995) Rapid angiographic progression of coronary artery disease in patients with angina pectoris. The role of complex stenosis morphology. Circulation 92(8):2058–2065

    Article  CAS  Google Scholar 

  29. Cheezum MK, Hulten EA, Smith RM, Taylor AJ, Kircher J, Surry L, York M, Villines TC (2013) Changes in preventive medical therapies and cv risk factors after CT angiography. JACC Cardiovasc Imaging 6(5):574–581

    Article  Google Scholar 

  30. Uretsky S, Rozanski A, Supariwala A, Thotakura G, Kanneganti S, Satyanarayana N, Mantrala P, Yeturi SR, Peters MR, Fisher E, Wolff SD (2013) Clinical outcomes following a strategy of optimized medical management and selective “downstream” procedures following coronary computed tomography angiography. Int J Cardiol 165(3):468–473

    Article  Google Scholar 

  31. Rozanski A, Gransar H, Shaw LJ, Kim J, Miranda-Peats L, Wong ND, Rana JS, Orakzai R, Hayes SW, Friedman JD, Thomson LE, Polk D, Min J, Budoff MJ, Berman DS (2011) Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial. J Am Coll Cardiol 57(15):1622–1632

    Article  CAS  Google Scholar 

  32. Chow BJ, Small G, Yam Y, Chen L, McPherson R, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng VY, Chinnaiyan K, Cury R, Delago A, Dunning A, Feuchtner G, Hadamitzky M, Hausleiter J, Karlsberg RP, Kaufmann PA, Kim YJ, Leipsic J, LaBounty T, Lin F, Maffei E, Raff GL, Shaw LJ, Villines TC, Min JK, Investigators C (2015) Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: an InteRnational Multicenter registry) registry. Arterioscler Thromb Vasc Biol 35(4):981–989

    Article  CAS  Google Scholar 

  33. Hwang IC, Jeon JY, Kim Y, Kim HM, Yoon YE, Lee SP, Kim HK, Sohn DW, Sung J, Kim YJ (2015) Statin therapy is associated with lower all-cause mortality in patients with non-obstructive coronary artery disease. Atherosclerosis 239(2):335–342

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The assistance of the Mayo Clinic Medical illustrations Unit with the figures is acknowledged with much thanks. Benjamin Chow receives research support from CV Diagnostix, and research and educational support from TeraRecon Inc. and holds the Saul & Edna Goldfarb Research Chair in Cardiac Imaging. There is no funding associated with this work.

Author information

Authors and Affiliations

  1. Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada

    Chadi Ayoub, Yeung Yam, Li Chen, Alomgir Hossain & Benjamin J. W. Chow

  2. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

    Chadi Ayoub

  3. University of Sydney, Sydney, NSW, Australia

    Chadi Ayoub & Leonard Kritharides

  4. Department of Cardiology, Concord Hospital, Sydney Local Health District, Sydney, NSW, Australia

    Leonard Kritharides

  5. Department of Medicine, University of Erlangen, Erlangen, Germany

    Stephan Achenbach

  6. King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Riyadh, Saudi Arabia

    Mouaz H. Al-Mallah

  7. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy

    Daniele Andreini & Gianluca Pontone

  8. Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Daniel S. Berman & Heidi Gransar

  9. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA

    Matthew J. Budoff

  10. Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy

    Filippo Cademartiri & Erica Maffei

  11. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA

    Tracy Q. Callister

  12. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea

    Hyuk-Jae Chang

  13. William Beaumont Hospital, Royal Oaks, MI, USA

    Kavitha Chinnaiyan & Gilbert Raff

  14. Baptist Cardiac and Vascular Institute, Miami, FL, USA

    Ricardo C. Cury

  15. Capitol Cardiology Associates, Albany, NY, USA

    Augustin Delago

  16. Duke Clinical Research Institute, Durham, NC, USA

    Allison Dunning

  17. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

    Gudrun Feuchtner

  18. Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA

    Millie Gomez, Niree Hindoyan & James K. Min

  19. Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany

    Martin Hadamitzky & Joerg Hausleiter

  20. University Hospital, Zurich, Switzerland

    Philipp A. Kaufmann

  21. Seoul National University Hospital, Seoul, South Korea

    Yong-Jin Kim

  22. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada

    Jonathon Leipsic

  23. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo Marques

  24. Department of Cardiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel

    Ronen Rubinshtein

  25. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Leslee J. Shaw

  26. Department of Medicine, Walter Reed Medical Center, Washington, DC, USA

    Todd C. Villines

  27. Department of Radiology, University of Ottawa, Ottawa, Canada

    Benjamin J. W. Chow

Authors
  1. Chadi Ayoub
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonard Kritharides
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yeung Yam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alomgir Hossain
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephan Achenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mouaz H. Al-Mallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniele Andreini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel S. Berman
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matthew J. Budoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Filippo Cademartiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tracy Q. Callister
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hyuk-Jae Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kavitha Chinnaiyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ricardo C. Cury
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Augustin Delago
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Allison Dunning
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Gudrun Feuchtner
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Millie Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Heidi Gransar
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Martin Hadamitzky
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Joerg Hausleiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Niree Hindoyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Philipp A. Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Yong-Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Jonathon Leipsic
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Erica Maffei
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Hugo Marques
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Gianluca Pontone
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Gilbert Raff
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. Ronen Rubinshtein
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. Leslee J. Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  33. Todd C. Villines
    View author publications

    You can also search for this author in PubMed Google Scholar

  34. James K. Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  35. Benjamin J. W. Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin J. W. Chow.

Ethics declarations

Conflict of interest

There is no funding associated with this work. Dr. Min received the modest speakers’ bureau and medical advisory board compensation and significant research support from GE Healthcare. Dr. Achenbach received grant support from Siemens and Bayer Schering Pharma and has served as a consultant for Servier. Dr. Al-Mallah received support from the American Heart Association, BCBS Foundation of Michigan, and Astellas. Dr. Cademartiri received grant support from GE Healthcare and has served on the Speakers’ Bureau of Bracco and as a consultant for Servier; Dr. Maffei received grant support from GE Healthcare. Dr. Chinnaiyan received grant support from Bayer Pharma and Blue Cross Blue Shield Blue Care MI. Dr. Chow received research and fellowship support from GE Healthcare, research support from Pfizer and AstraZeneca, and educational support from TeraRecon. Dr. Hausleiter received a research grant from Siemens Medical Systems. Dr. Kaufmann received institutional research support from GE Healthcare and grant support from Swiss National Science Foundation. Dr. Maffei received grant support from GE Healthcare Dr. Raff received grant support from Siemens, Blue Cross Blue Shield Blue Care MI, and Bayer Pharma. Dr. Leipsic has received research support and serves on the speaker’s bureau for GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from individual participants included in the study or was waived by the institutional research board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ayoub, C., Kritharides, L., Yam, Y. et al. Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age. Heart Vessels 33, 1288–1300 (2018). https://doi.org/10.1007/s00380-018-1188-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1188-3

Keywords

Search

Navigation