Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

van Rosendael AR, Bax AM, van den Hoogen IJ, Smit JM, Al'Aref SJ, 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, Narula J, Min JK, Bax JJ (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 23

Pages Range: 266-274

Journal Issue: 2

DOI: 10.1093/ehjci/jeaa323

Abstract

AIMS : The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. METHODS AND RESULTS : From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. CONCLUSION : In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.

Authors with CRIS profile

Involved external institutions

Leiden University Medical Center Netherlands (NL) SDN Istituto di Ricerca Diagnostica e Nucleare Italy (IT) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Hospital da Luz Portugal (PT) Centro Cardiologico Monzino (IRCCS) Italy (IT) New York Presbyterian Hospital United States (USA) (US) Baptist Health South Florida United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH) Weill Cornell Medicine United States (USA) (US) Houston Methodist United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) The Lundquist Institute for Biomedical Innovation United States (USA) (US) Yonsei University Health System (YUHS) Korea, Republic of (KR) Beaumont Health United States (USA) (US) University of Ottawa Canada (CA) Capitol Cardiology Associates United States (USA) (US) Medizinische Universität Innsbruck Austria (AT) Deutsches Herzzentrum München Germany (DE) Klinikum der Universität München Germany (DE) University of British Columbia Canada (CA) Carmel Medical Center Israel (IL) Icahn School of Medicine at Mount Sinai United States (USA) (US)

How to cite

APA:

van Rosendael, A.R., Bax, A.M., van den Hoogen, I.J., Smit, J.M., Al'Aref, S.J., Achenbach, S.,... Bax, J.J. (2022). Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry. European Heart Journal - Cardiovascular Imaging, 23(2), 266-274. https://dx.doi.org/10.1093/ehjci/jeaa323

MLA:

van Rosendael, Alexander R., et al. "Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry." European Heart Journal - Cardiovascular Imaging 23.2 (2022): 266-274.

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