Mortality Risk in Symptomatic Patients With Nonobstructive Coronary Artery Disease

  • Lin F
  • Shaw L
  • Dunning A
  • et al.
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Objectives Background Methods The prognostic significance of nonobstructive coronary artery plaques by CCTA is poorly understood. We prospectively evaluated consecutive adults from 2 centers undergoing 64-detector row CCTA without prior documented coronary artery disease (CAD) and without obstructive (50%) CAD by CCTA. Luminal diameter ste- nosis severity was classified for each segment as none (0%) or mild (1% to 49%), and plaque composition was classified as noncalcified, calcified, or mixed. Results During 3.1  0.5 years, 54 intermediate-term (90 days) deaths occurred among 2,583 patients (2.09%), with 4 early (90 days) deaths. Adjusted for CAD risk factors, the presence of any nonobstructive plaque was associ- ated with higher mortality (hazard ratio [HR]: 1.98, 95% confidence Interval [CI]: 1.06 to 3.69, p  0.03), with the highest risk among those exhibiting nonobstructive CAD in 3 epicardial vessels (HR: 4.75, 95% CI: 2.10 to 10.75, p  0.0002) or 5 segments (HR: 5.12, 95% CI: 2.16 to 12.10, p  0.0002). Higher mortality for nonob- structive CAD was observed even among patients with low 10-year Framingham risk (3.4%, p  0.0001) as well as those with no traditional, medically treatable CAD risk factors, including diabetes mellitus, hypertension, and dyslipidemia (6.7%, p  0.0001). No independent relationship between plaque composition and incident mortal- ity was observed. Importantly, patients without evident plaque experienced a low rate of incident death during follow-up (0.34%/year). Conclusions The presence and extent of nonobstructive plaques augment prediction of incident mortality beyond conven- tional clinical risk assessment. (J




Lin, F. Y., Shaw, L. J., Dunning, A. M., LaBounty, T. M., Choi, J.-H., Weinsaft, J. W., … Min, J. K. (2011). Mortality Risk in Symptomatic Patients With Nonobstructive Coronary Artery Disease. Journal of the American College of Cardiology, 58(5), 510–519.

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