Back to Search
Start Over
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
- Source :
- European heart journal. Cardiovascular Imaging, vol 21, iss 5, European Heart Journal-Cardiovascular Imaging, 21(5), 479-488. OXFORD UNIV PRESS
- Publication Year :
- 2020
- Publisher :
- eScholarship, University of California, 2020.
-
Abstract
- 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.
- Subjects :
- Male
Aging
Computed Tomography Angiography
medicine.medical_treatment
Coronary Artery Disease
risk stratification
030204 cardiovascular system & hematology
Coronary Angiography
Cardiovascular
Coronary artery disease
0302 clinical medicine
Risk Factors
2.1 Biological and endogenous factors
Registries
030212 general & internal medicine
Myocardial infarction
Hazard ratio
Diabetes
imaging
General Medicine
Middle Aged
Prognosis
Plaque, Atherosclerotic
Heart Disease
Cardiology
Biomedical Imaging
Female
Patient Safety
Cardiology and Cardiovascular Medicine
4.2 Evaluation of markers and technologies
medicine.medical_specialty
Revascularization
03 medical and health sciences
Predictive Value of Tests
Clinical Research
Internal medicine
Diabetes mellitus
medicine
Humans
Radiology, Nuclear Medicine and imaging
cardiovascular diseases
Heart Disease - Coronary Heart Disease
Aged
Proportional hazards model
business.industry
preventive cardiology
Prevention
medicine.disease
Atherosclerosis
coronary computed tomography angiography
atherosclerosis
business
Body mass index
Mace
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- European heart journal. Cardiovascular Imaging, vol 21, iss 5, European Heart Journal-Cardiovascular Imaging, 21(5), 479-488. OXFORD UNIV PRESS
- Accession number :
- edsair.doi.dedup.....30a486585336b9bcd63c921a20a8af60