{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:09:33Z","timestamp":1785557373927,"version":"3.56.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age\u2013sex percentiles of segment involvement score (SIS) at each year of life (40\u201379 years). The relationship between SIS age\u2013sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (\u226450th, 51\u201375th, and &gt;75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age\u2013sex percentiles were well fitted to second-order polynomial curves (men:\n              <jats:italic>R<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =0.86\u00b10.12; women:\n              <jats:italic>R<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =0.86\u00b10.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the \u226450th, 51\u201375th, and &gt;75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%\u20132.7%], 3.9% [95% confidence interval: 3.0%\u20135.1%], and 7.2% [95% confidence interval: 5.4%\u20139.6%] in \u226450th, 51\u201375th, and &gt;75th SIS% groups, respectively;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3\u20132.8] for 51\u201375th SIS% group and 3.4 [2.3\u20135.0] for &gt;75th SIS% group;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01 for both).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>We have developed clinically pragmatic age- and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT01443637.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.116.004896","type":"journal-article","created":{"date-parts":[[2017,3,15]],"date-time":"2017-03-15T00:55:14Z","timestamp":1489539314000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events"],"prefix":"10.1161","volume":"10","author":[{"given":"Christopher","family":"Naoum","sequence":"first","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Berman","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Blanke","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Gransar","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagat","family":"Narula","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslee J.","family":"Shaw","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Kritharides","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Achenbach","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mouaz H.","family":"Al-Mallah","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Andreini","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Budoff","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Cademartiri","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy Q.","family":"Callister","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuk-Jae","family":"Chang","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Chinnaiyan","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Chow","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo C.","family":"Cury","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustin","family":"DeLago","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Dunning","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudrun","family":"Feuchtner","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Hadamitzky","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Hausleiter","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp A.","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Maffei","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Marquez","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Pontone","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert","family":"Raff","sequence":"additional","affiliation":[{"name":"From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); 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