Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: The long-term coronary computed tomography angiography CONFIRM registry


Alexander R. Van Rosendael, Weill Cornell Medicine
A. Maxim Bax, Weill Cornell Medicine
Jeff M. Smit, Leiden University Medical Center - LUMC
Inge J. Van Den Hoogen, Weill Cornell Medicine
Xiaoyue Ma, Weill Cornell Medicine
Subhi Al'Aref, Weill Cornell Medicine
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Mouaz H. Al-Mallah, Methodist Hospital Houston
Daniele Andreini, IRCCS Centro Cardiologico Monzino
Daniel S. Berman, Cedars-Sinai Medical Center
Matthew J. Budoff, The Lundquist Institute
Filippo Cademartiri, IRCCS Fondazione SDN
Tracy Q. Callister
Hyuk Jae Chang, Severance Hospital
Kavitha Chinnaiyan, William Beaumont Hospital
Benjamin J.W. Chow, University of Ottawa, Canada
Ricardo C. Cury, Baptist Cardiac and Vascular Institute
Augustin Delago, Capitol Cardiology Associates
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Philipp A. Kaufmann, UniversitatsSpital Zurich
Yong Jin Kim, Seoul National University Hospital
Jonathon A. Leipsic, The University of British Columbia
Erica Maffei
Hugo Marques, Hospital da Luz
Pedro De Araújo Gonçalves, Hospital da Luz
Gianluca Pontone, IRCCS Centro Cardiologico Monzino
Gilbert L. Raff, William Beaumont Hospital
Ronen Rubinshtein, Technion - Israel Institute of Technology
Todd C. Villines, University of Virginia Health System
Heidi Gransar, Cedars-Sinai Medical Center
Yao Lu, Weill Cornell Medicine

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European Heart Journal Cardiovascular Imaging


© 2020 Published on behalf of the European Society of Cardiology. All rights reserved. Aims: In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. Methods and results: Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3-4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3-2.2) and 1.4 (95% CI 1.1-1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004). Conclusion: Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.





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