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Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events.
Circ Cardiovasc Imaging. 2014 Mar; 7(2):282-91.CC

Abstract

BACKGROUND

The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography.

METHODS AND RESULTS

All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (<50% stenosis), or obstructive (≥50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (≤4 segments) or extensive (>4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1-5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5-6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3-6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2-7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction.

CONCLUSIONS

Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment.

Authors+Show Affiliations

Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.No 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24550435

Citation

Bittencourt, Marcio Sommer, et al. "Prognostic Value of Nonobstructive and Obstructive Coronary Artery Disease Detected By Coronary Computed Tomography Angiography to Identify Cardiovascular Events." Circulation. Cardiovascular Imaging, vol. 7, no. 2, 2014, pp. 282-91.
Bittencourt MS, Hulten E, Ghoshhajra B, et al. Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging. 2014;7(2):282-91.
Bittencourt, M. S., Hulten, E., Ghoshhajra, B., O'Leary, D., Christman, M. P., Montana, P., Truong, Q. A., Steigner, M., Murthy, V. L., Rybicki, F. J., Nasir, K., Gowdak, L. H., Hainer, J., Brady, T. J., Di Carli, M. F., Hoffmann, U., Abbara, S., & Blankstein, R. (2014). Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circulation. Cardiovascular Imaging, 7(2), 282-91. https://doi.org/10.1161/CIRCIMAGING.113.001047
Bittencourt MS, et al. Prognostic Value of Nonobstructive and Obstructive Coronary Artery Disease Detected By Coronary Computed Tomography Angiography to Identify Cardiovascular Events. Circ Cardiovasc Imaging. 2014;7(2):282-91. PubMed PMID: 24550435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. AU - Bittencourt,Marcio Sommer, AU - Hulten,Edward, AU - Ghoshhajra,Brian, AU - O'Leary,Daniel, AU - Christman,Mitalee P, AU - Montana,Philip, AU - Truong,Quynh A, AU - Steigner,Michael, AU - Murthy,Venkatesh L, AU - Rybicki,Frank J, AU - Nasir,Khurram, AU - Gowdak,Luis Henrique W, AU - Hainer,Jon, AU - Brady,Thomas J, AU - Di Carli,Marcelo F, AU - Hoffmann,Udo, AU - Abbara,Suhny, AU - Blankstein,Ron, Y1 - 2014/02/18/ PY - 2014/2/20/entrez PY - 2014/2/20/pubmed PY - 2014/8/6/medline KW - coronary artery disease KW - prognosis KW - risk assessment SP - 282 EP - 91 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 7 IS - 2 N2 - BACKGROUND: The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography. METHODS AND RESULTS: All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (<50% stenosis), or obstructive (≥50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (≤4 segments) or extensive (>4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1-5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5-6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3-6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2-7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction. CONCLUSIONS: Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/24550435/Prognostic_value_of_nonobstructive_and_obstructive_coronary_artery_disease_detected_by_coronary_computed_tomography_angiography_to_identify_cardiovascular_events_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.113.001047?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -