Adverse Cardiovascular Events Among Younger and Older Patients Referred for Coronary Computed Tomography Angiography (CTA): The Mass General Brigham CCTA Registry
Authors' conclusion
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.
Study context
- Population
- Patients clinically referred to coronary CTA at 2 centres, 2006–2021, without prior coronary artery disease (CAD), severe renal disease or malignancy
- Participants
- 22,412 participants
- Exposure
- Coronary CTA findings by age: <65 vs ≥65 years
- <65 yearsn = 16,726
- ≥65 yearsn = 5,686
- Outcome
- MACE (CV death, nonfatal MI or ischemic stroke) by CAD severity and extent
- Follow-up
- Median 6.2 years (Q1-Q3: 3.9-9.6 years)
Methodological details2 medical centres, registry
- 2 medical centres
- Registry
Main finding
As reported in the abstract
- Obstructive CAD · <65 years
- HR 2.45; P < 0.001
- Obstructive CAD · ≥65 years
- HR 1.97; P < 0.001
- Nonobstructive plaque · <65 years
- HR 1.39; P = 0.005
- Extensive nonobstructive CAD · ≥65 years; only extensive nonobstructive CAD associated
- HR 1.56; P = 0.02
Observational data: associations, not effects.
Further findings
Nonobstructive plaque
Prevalence of obstructive CAD
- Older vs younger patients
- 38% vs 15%
Extensive plaque (3- to 4-vessel involvement)
- Older vs younger patients
- 52% vs 20%
Revascularization after early invasive coronary angiography (obstructive CAD on CTA)
- Less common among older adults
- 48% vs 56%; P = 0.002
Original publication
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