Adverse Cardiovascular Events Among Younger and Older Patients Referred for Coronary CTA

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2026-05-01 Epub Date: 2026-02-19 DOI:10.1016/j.jcmg.2025.12.012

Daniel M. Huck MD, MPH , Adam N. Berman MD, MPH , Arthur Shiyovich MD , Brittany N. Weber MD, PhD , Rhanderson Cardoso MD , Camila V. Blair MD , David W. Biery BS , Stephanie A. Besser MS , Sumit Gupta MBBS, PhD , Ayaz Aghayev MD , Michael Steigner MD , Joanne Miao BS , Jon Hainer BS , Cian McCarthy MB, BCH, BAO, SM , Sandeep Hedgire MD , Khurram Nasir MD, MPH , Leslee J. Shaw PhD , Marcelo F. Di Carli MD , Brian Ghoshhajra MD, MBA , Ron Blankstein MD

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引用次数: 0

Abstract

Background

Recent guidelines suggest that coronary computed tomography angiography (CTA) may be the preferred testing modality in patients <65 years of age who are suspected of having coronary artery disease (CAD). Because of a higher prevalence of CAD, the role of coronary CTA in older cohorts is less well established.

Objectives

The authors aimed to characterize the yield and prognostic utility of coronary CTA by age in a large registry with long-term follow-up.

Methods

Retrospective cohort of patients clinically referred to coronary CTA at 2 medical centers from 2006 to 2021, excluding patients with prior CAD, severe renal disease, and malignancy. Adjusted Cox regression was used to assess the association of CAD severity (absent, nonobstructive, obstructive) and extent (number of vessels with plaque) with adverse cardiovascular events (major adverse cardiovascular events [MACE]: cardiovascular death, nonfatal myocardial infarction, or ischemic stroke) across different age groups.

Results

Among 22,412 patients followed over a median of 6.2 years (Q1-Q3: 3.9-9.6 years), 16,726 were <65 years of age and 5,686 were ≥65 years of age. Older patients had a higher prevalence of obstructive CAD (38% vs 15%) and extensive plaque (52% vs 20% with 3- to 4-vessel involvement) compared with their younger counterparts. Nonobstructive plaque was common in both groups (<65 years of age: 37%; ≥65 years of age: 48%). Obstructive CAD was associated with MACE in both younger (HR: 2.45; P < 0.001) and older individuals (HR: 1.97; P < 0.001). Nonobstructive plaque was associated with MACE in younger individuals (HR: 1.39; P = 0.005), whereas only extensive nonobstructive CAD was associated with MACE in older individuals (HR: 1.56; P = 0.02). Among those with obstructive CAD on coronary CTA who underwent early invasive coronary angiography, revascularization was less common among older adults (48% vs 56%; P = 0.002).

Conclusions

In a large coronary CTA registry, patients ≥65 years of age were more likely to have extensive plaque and stenosis. Although the prognostic value of coronary CTA may be lower among older adults with nonobstructive plaque (a group that has a similar event rate as those with no CAD), the presence of extensive nonobstructive plaque or obstructive stenosis was independently associated with a significantly higher rate of MACE. Newer techniques to better risk stratify patients with nonobstructive plaque may improve the value of coronary CTA, especially in older adults.

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在接受冠状动脉CTA的年轻和老年患者中的不良心血管事件：麻省总医院布里格姆CCTA登记。

背景：最近的指南建议冠状动脉计算机断层血管造影（CTA）可能是患者首选的检测方式目的：作者旨在通过长期随访的大型登记来描述冠状动脉CTA按年龄的产量和预后效用。方法：对2006年至2021年在2个医疗中心进行冠状动脉CTA临床转诊的患者进行回顾性队列研究，排除既往有CAD、严重肾脏疾病和恶性肿瘤的患者。采用校正Cox回归评估不同年龄组冠心病严重程度（无、非阻塞性、阻塞性）和程度（有斑块的血管数量）与心血管不良事件（主要心血管不良事件[MACE]：心血管死亡、非致死性心肌梗死或缺血性卒中）的相关性。结果：在22412例患者中位随访时间为6.2年（Q1-Q3: 3.9-9.6年），16726例患者在一项大型冠状动脉CTA登记中，≥65岁的患者更容易出现广泛的斑块和狭窄。尽管冠状动脉CTA的预后价值在有非阻塞性斑块的老年人中可能较低（这一组的事件发生率与无CAD的老年人相似），但广泛的非阻塞性斑块或阻塞性狭窄的存在与显著较高的MACE发生率独立相关。新的技术可以更好地对非阻塞性斑块患者进行风险分层，这可能会提高冠状动脉CTA的价值，尤其是在老年人中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.