October 6, 2016Open Access
View Full PaperImproved 5-year prediction of all-cause mortality by coronary CT angiography applying the CONFIRM score
Key Result
The CONFIRM score significantly improved the prediction of all-cause mortality over the NCEP ATP III score in patients undergoing CCTA (categorical NRI 0.06; 95% CI 0.02-0.10; P=0.005).
Study Design
Type
Cohort (n=15,219)
Multicenter
Yes
Structured PICO
Does the CONFIRM score improve prediction of all-cause mortality compared to traditional clinical risk scores in patients undergoing CCTA?
P
Population
15,219 patients undergoing coronary computed tomography angiography (CCTA) from the international multicentre CONFIRM registry
I
Intervention
CONFIRM score (CCTA-based risk prediction model)
C
Comparator
Clinical risk scores (Morise, Framingham, and NCEP ATP III score)
O
Outcome
All-cause mortalityhard clinical
The CONFIRM score derived from CCTA provides significantly better long-term prediction of all-cause mortality compared to traditional clinical risk scores.
Main Result
Effect estimate: categorical NRI 0.06 (95% CI 0.02-0.10)
p-value: p=0.005
Abstract
AIMS: To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS: Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality. The predictive value of the CONFIRM score over clinical risk scores (Morise, Framingham, and NCEP ATP III score) was studied in the entire patient population as well as in subgroups. Improvement in risk prediction and patient reclassification were assessed using categorical net reclassification index (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 5.3 years, 982 (6.5%) of 15 219 patients died. The CONFIRM score outperformed the prognostic value of the studied three clinical risk scores (c-indices: CONFIRM score 0.696, NCEP ATP III score 0.675, Framingham score 0.610, Morise score 0.606; c-index for improvement CONFIRM score vs. NCEP ATP III score 0.650, P 5 years after CCTA. These findings are consistent in a large variety of patient subgroups.