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

van Rosendael AR, Bax AM, Smit JM, van den Hoogen IJ, Ma X, Al'Aref S, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJ, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Gransar H, Lu Y, Peña JM, Lin FY, Shaw LJ, Min JK, Bax JJ (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Book Volume: 21

Pages Range: 479-488

Journal Issue: 5

DOI: 10.1093/ehjci/jez322

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.

Authors with CRIS profile

Involved external institutions

Hospital da Luz Portugal (PT) Beaumont Health United States (USA) (US) New York Presbyterian Hospital United States (USA) (US) Leiden University Medical Center Netherlands (NL) Cedars-Sinai Medical Center United States (USA) (US) University of Ottawa Canada (CA) Medizinische Universität Innsbruck Austria (AT) Capitol Cardiology Associates United States (USA) (US) University of British Columbia Canada (CA) Ludwig-Maximilians-Universität (LMU) Germany (DE) Centro Cardiologico Monzino (IRCCS) Italy (IT) SDN Istituto di Ricerca Diagnostica e Nucleare Italy (IT) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Deutsches Herzzentrum München Germany (DE) Severance Hospital / 세브란스 병원 Korea, Republic of (KR) Technion - Israel Institute of Technology Israel (IL) The Lundquist Institute for Biomedical Innovation United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH) University of Virginia Health System United States (USA) (US) Baptist Health South Florida United States (USA) (US)

How to cite

APA:

van Rosendael, A.R., Bax, A.M., Smit, J.M., van den Hoogen, I.J., Ma, X., Al'Aref, S.,... Bax, J.J. (2020). 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. European Heart Journal - Cardiovascular Imaging, 21(5), 479-488. https://dx.doi.org/10.1093/ehjci/jez322

MLA:

van Rosendael, Alexander R., et al. "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." European Heart Journal - Cardiovascular Imaging 21.5 (2020): 479-488.

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