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Cardiovascular risk among stable individuals suspected of having coronary artery disease with no modifiable risk factors: results from an international multicenter study of 5262 patients.
Radiology. 2013 Jun; 267(3):718-26.R

Abstract

PURPOSE

To assess the prevalence, extent, severity, and risk of coronary artery disease (CAD) in patients suspected of having CAD but with no medically modifiable risk factors.

MATERIALS AND METHODS

Institutional review board approval or waiver of consent was obtained at each center. This study was HIPAA compliant. From an international multicenter cohort study of 27 125 subjects undergoing coronary computed tomographic (CT) angiography from 12 centers, 5262 patients without known CAD and without modifiable risk factors were identified. CAD severity was defined as none (0%), mild (1%-49%), or obstructive (≥ 50%) on a per-patient, per-vessel, and per-segment basis. CAD presence, extent, and severity were related to incidence of major adverse cardiovascular event (MACE) by using Cox proportional hazards models.

RESULTS

At a mean follow-up of 2.3 years ± 1.2 (standard deviation), MACE occurred in 106 patients. CAD was common for nonobstructive (n = 1452, 27%) and obstructive (n = 629, 12%) CAD. In risk-adjusted analysis, per-patient obstructive CAD (hazard ratio [HR], 6.64; 95% confidence interval [CI]: 3.68, 12.00; P ≤ .001) was related to MACE. MACE was associated with a dose-response relationship to the number of vessels exhibiting obstructive CAD, increasing risk for obstructive one-vessel (HR, 6.11; 95% CI: 3.22, 11.6; P ≤ .001), two-vessel (HR, 5.86; 95% CI: 2.75, 12.5; P ≤ .0001), or three-vessel or left main (HR, 11.69; 95% CI: 5.38, 25.4; P ≤ .001) CAD. The increased hazard for MACE of obstructive disease holds true for symptomatic (HR, 11.9; 95% CI: 4.81, 29.6; P ≤ .001) and asymptomatic (HR, 6.3; 95% CI: 2.4, 16.7; P ≤ .001) patients. No CAD at coronary CT angiography was associated with a low annualized MACE rate: 0.31% versus 2.06% with obstructive disease.

CONCLUSION

Among individuals suspected of having CAD but without modifiable risk factors, CAD is common, with significantly increased hazards for MACE and mortality.

Authors+Show Affiliations

Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada. jleipsic@providencehealth.bc.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

23424261

Citation

Leipsic, Jonathon, et al. "Cardiovascular Risk Among Stable Individuals Suspected of Having Coronary Artery Disease With No Modifiable Risk Factors: Results From an International Multicenter Study of 5262 Patients." Radiology, vol. 267, no. 3, 2013, pp. 718-26.
Leipsic J, Taylor CM, Grunau G, et al. Cardiovascular risk among stable individuals suspected of having coronary artery disease with no modifiable risk factors: results from an international multicenter study of 5262 patients. Radiology. 2013;267(3):718-26.
Leipsic, J., Taylor, C. M., Grunau, G., Heilbron, B. G., Mancini, G. B., Achenbach, S., Al-Mallah, M., Berman, D. S., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Cheng, V. Y., Chinnaiyan, K., Chow, B. J., Delago, A., Hadamitzky, M., Hausleiter, J., Cury, R., ... Min, J. K. (2013). Cardiovascular risk among stable individuals suspected of having coronary artery disease with no modifiable risk factors: results from an international multicenter study of 5262 patients. Radiology, 267(3), 718-26. https://doi.org/10.1148/radiol.13121669
Leipsic J, et al. Cardiovascular Risk Among Stable Individuals Suspected of Having Coronary Artery Disease With No Modifiable Risk Factors: Results From an International Multicenter Study of 5262 Patients. Radiology. 2013;267(3):718-26. PubMed PMID: 23424261.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular risk among stable individuals suspected of having coronary artery disease with no modifiable risk factors: results from an international multicenter study of 5262 patients. AU - Leipsic,Jonathon, AU - Taylor,Carolyn M, AU - Grunau,Gilat, AU - Heilbron,Brett G, AU - Mancini,G B John, AU - Achenbach,Stephan, AU - Al-Mallah,Mouaz, AU - Berman,Daniel S, AU - Budoff,Matthew J, AU - Cademartiri,Filippo, AU - Callister,Tracy Q, AU - Chang,Hyuk-Jae, AU - Cheng,Victor Y, AU - Chinnaiyan,Kavitha, AU - Chow,Benjamin J W, AU - Delago,Augustin, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Cury,Ricardo, AU - Feuchtner,Gudrun, AU - Kim,Yong-Jin, AU - Kaufmann,Philipp A, AU - Lin,Fay Y, AU - Maffei,Erica, AU - Raff,Gilbert, AU - Shaw,Leslee J, AU - Villines,Todd C, AU - Min,James K, Y1 - 2013/02/19/ PY - 2013/2/21/entrez PY - 2013/2/21/pubmed PY - 2013/8/10/medline SP - 718 EP - 26 JF - Radiology JO - Radiology VL - 267 IS - 3 N2 - PURPOSE: To assess the prevalence, extent, severity, and risk of coronary artery disease (CAD) in patients suspected of having CAD but with no medically modifiable risk factors. MATERIALS AND METHODS: Institutional review board approval or waiver of consent was obtained at each center. This study was HIPAA compliant. From an international multicenter cohort study of 27 125 subjects undergoing coronary computed tomographic (CT) angiography from 12 centers, 5262 patients without known CAD and without modifiable risk factors were identified. CAD severity was defined as none (0%), mild (1%-49%), or obstructive (≥ 50%) on a per-patient, per-vessel, and per-segment basis. CAD presence, extent, and severity were related to incidence of major adverse cardiovascular event (MACE) by using Cox proportional hazards models. RESULTS: At a mean follow-up of 2.3 years ± 1.2 (standard deviation), MACE occurred in 106 patients. CAD was common for nonobstructive (n = 1452, 27%) and obstructive (n = 629, 12%) CAD. In risk-adjusted analysis, per-patient obstructive CAD (hazard ratio [HR], 6.64; 95% confidence interval [CI]: 3.68, 12.00; P ≤ .001) was related to MACE. MACE was associated with a dose-response relationship to the number of vessels exhibiting obstructive CAD, increasing risk for obstructive one-vessel (HR, 6.11; 95% CI: 3.22, 11.6; P ≤ .001), two-vessel (HR, 5.86; 95% CI: 2.75, 12.5; P ≤ .0001), or three-vessel or left main (HR, 11.69; 95% CI: 5.38, 25.4; P ≤ .001) CAD. The increased hazard for MACE of obstructive disease holds true for symptomatic (HR, 11.9; 95% CI: 4.81, 29.6; P ≤ .001) and asymptomatic (HR, 6.3; 95% CI: 2.4, 16.7; P ≤ .001) patients. No CAD at coronary CT angiography was associated with a low annualized MACE rate: 0.31% versus 2.06% with obstructive disease. CONCLUSION: Among individuals suspected of having CAD but without modifiable risk factors, CAD is common, with significantly increased hazards for MACE and mortality. SN - 1527-1315 UR - https://www.unboundmedicine.com/medline/citation/23424261/Cardiovascular_risk_among_stable_individuals_suspected_of_having_coronary_artery_disease_with_no_modifiable_risk_factors:_results_from_an_international_multicenter_study_of_5262_patients_ L2 - https://pubs.rsna.org/doi/10.1148/radiol.13121669?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -