Prognostic Value of CCTA Findings in Asymptomatic Patients

Study Questions:

What is the long-term prognostic implication of coronary computed tomographic angiography (CCTA) findings of coronary artery disease (CAD) in asymptomatic populations?


The investigators evaluated asymptomatic subjects without known CAD who underwent both coronary artery calcium scoring (CACS) and CCTA (n = 1,226) in the prospective multicenter international CONFIRM long-term study. CCTA findings included the severity of coronary artery stenosis, plaque composition, and coronary segment location. Using the C-statistic and likelihood ratio tests, the authors evaluated the incremental prognostic utility of CCTA findings over a base model that included a panel of traditional risk factors (RFs) as well as CACS to predict long-term all-cause mortality.


During a mean follow-up of 5.9 ± 1.2 years, 78 deaths occurred. Compared with the traditional RF alone (C-statistic, 0.64), CCTA findings including coronary stenosis severity, plaque composition, and coronary segment location demonstrated improved incremental prognostic utility beyond traditional RFs alone (C-statistics range, 0.71-0.73; all p < 0.05; incremental χ2 range, 20.7-25.5; all p < 0.001). However, no added prognostic benefit was offered by CCTA findings when added to a base model containing both traditional RFs and CACS (C-statistics p > 0.05, for all).


The authors concluded that CCTA improved prognostication of 6-year all-cause mortality beyond a set of conventional RFs alone, but there was no incremental value when CCTA findings were added to a model incorporating RFs and CACS.


This study reports that the incremental risk-predictive benefit of comprehensive CAD information by CCTA, including degree and extent of plaque, coronary segment location, and plaque composition, over traditional RFs and CACS model, was negligible in an asymptomatic population across a long-term follow-up. Based on this and other available data, CCTA should not be considered for future cardiovascular risk stratification in asymptomatic individuals. The 2010 American College of Cardiology Foundation/American Heart Association guideline for assessment of cardiovascular risk in asymptomatic adults gives a Class III (No Benefit) label for CCTA in asymptomatic patients and states that CCTA is not recommended for cardiovascular risk assessment in asymptomatic adults.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Angiography, Atherosclerosis, Coronary Angiography, Coronary Artery Disease, Coronary Stenosis, Diagnostic Imaging, Plaque, Atherosclerotic, Primary Prevention, Prognosis, Risk Assessment, Risk Factors, Tomography, X-Ray Computed

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