Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)

Ji Hyun Lee, Weill Cornell Medicine
Donghee Han, Weill Cornell Medicine
Bríain Hartaigh, Weill Cornell Medicine
Heidi Gransar, Myongji University
Yao Lu, Weill Cornell Medicine
Asim Rizvi, Weill Cornell Medicine
Mahn Won Park, Weill Cornell Medicine
Hadi Mirhedayati Roudsari, Weill Cornell Medicine
Wijnand J. Stuijfzand, Weill Cornell Medicine
Daniel S. Berman, Cedars-Sinai Medical Center
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Augustin DeLago, Capitol Cardiology Associates
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Mouaz H. Al-Mallah, King Saud bin Abdulaziz University for Health Sciences
Matthew J. Budoff, Harbor-UCLA Medical Center
Philipp A. Kaufmann, UniversitatsSpital Zurich
Gilbert Raff, William Beaumont Hospital
Kavitha Chinnaiyan, William Beaumont Hospital
Filippo Cademartiri, IRCCS Fondazione SDN
Erica Maffei
Todd C. Villines, Walter Reed National Military Medical Center
Yong Jin Kim, Seoul National University Hospital
Jonathon Leipsic, The University of British Columbia
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Gianluca Pontone, Università degli Studi di Milano
Daniele Andreini, Università degli Studi di Milano
Hugo Marques, Hospital da Luz
Ronen Rubinshtein, Technion - Israel Institute of Technology
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Leslee J. Shaw, Emory University School of Medicine
Hyuk Jae Chang, Yonsei University College of Medicine
Jeroen Bax, Leiden University Medical Center - LUMC


© 2018 Wiley Periodicals, Inc. Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%–49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6–5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06–2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34–1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.