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Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry).
Clin Cardiol. 2018 May; 41(5):586-593.CC

Abstract

Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%-49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6-5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06-2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34-1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.

Authors+Show Affiliations

Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Goyang-si, South Korea.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Goyang-si, South Korea.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.Tennessee Heart and Vascular Institute, Hendersonville, Tennessee.Capitol Cardiology Associates, Albany, New York.Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.King Saud bin Abdulaziz University of Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia.Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, California.Department of Nuclear Medicine, Cardiac Imaging, University Hospital, Zurich, University of Zurich, Switzerland.William Beaumont Hospital, Royal, Michigan.William Beaumont Hospital, Royal, Michigan.Cardiovascular Imaging Center, Department of Radiology, SDN IRCCS Naples, Italy.Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.Department of Medicine, Walter Reed Medical Center, Washington, D.C.Cardiovascular Center and Internal Medicine, Seoul National University Hospital, Seoul, South Korea.Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.UNICA, Cardiac CT and MRI Unit, Hospital da Luz, Lisbon, Portugal.Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.Department of Medicine, University of Erlangen, Erlangen, Germany.Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Department of Cardiology, Leiden University Medical Center, HARTS, Leiden, The Netherlands.Department of Medicine and Radiology, University of Ottawa, Ontario, Canada.Baptist Cardiac and Vascular Institute, Miami, Florida.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

29521447

Citation

Lee, Ji Hyun, et al. "Influence of Symptom Typicality for Predicting MACE in Patients Without Obstructive Coronary Artery Disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: an International Multicenter Registry)." Clinical Cardiology, vol. 41, no. 5, 2018, pp. 586-593.
Lee JH, Han D, Hartaigh BÓ, et al. Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry). Clin Cardiol. 2018;41(5):586-593.
Lee, J. H., Han, D., Hartaigh, B. Ó., Gransar, H., Lu, Y., Rizvi, A., Park, M. W., Roudsari, H. M., Stuijfzand, W. J., Berman, D. S., Callister, T. Q., DeLago, A., Hadamitzky, M., Hausleiter, J., Al-Mallah, M. H., Budoff, M. J., Kaufmann, P. A., Raff, G., Chinnaiyan, K., ... Peña, J. M. (2018). Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry). Clinical Cardiology, 41(5), 586-593. https://doi.org/10.1002/clc.22940
Lee JH, et al. Influence of Symptom Typicality for Predicting MACE in Patients Without Obstructive Coronary Artery Disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: an International Multicenter Registry). Clin Cardiol. 2018;41(5):586-593. PubMed PMID: 29521447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry). AU - Lee,Ji Hyun, AU - Han,Donghee, AU - Hartaigh,Bríain Ó, AU - Gransar,Heidi, AU - Lu,Yao, AU - Rizvi,Asim, AU - Park,Mahn Won, AU - Roudsari,Hadi Mirhedayati, AU - Stuijfzand,Wijnand J, AU - Berman,Daniel S, AU - Callister,Tracy Q, AU - DeLago,Augustin, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Al-Mallah,Mouaz H, AU - Budoff,Matthew J, AU - Kaufmann,Philipp A, AU - Raff,Gilbert, AU - Chinnaiyan,Kavitha, AU - Cademartiri,Filippo, AU - Maffei,Erica, AU - Villines,Todd C, AU - Kim,Yong-Jin, AU - Leipsic,Jonathon, AU - Feuchtner,Gudrun, AU - Pontone,Gianluca, AU - Andreini,Daniele, AU - Marques,Hugo, AU - Rubinshtein,Ronen, AU - Achenbach,Stephan, AU - Shaw,Leslee J, AU - Chang,Hyuk-Jae, AU - Bax,Jeroen, AU - Chow,Benjamin, AU - Cury,Ricardo C, AU - Gomez,Millie, AU - Jones,Erica C, AU - Lin,Fay Y, AU - Min,James K, AU - Peña,Jessica M, Y1 - 2018/05/11/ PY - 2017/11/03/received PY - 2018/02/27/revised PY - 2018/03/04/accepted PY - 2018/3/10/pubmed PY - 2018/10/16/medline PY - 2018/3/10/entrez KW - Coronary Artery Disease KW - Coronary Computed Tomographic Angiography KW - Major Adverse Cardiac Events KW - Symptom Typicality SP - 586 EP - 593 JF - Clinical cardiology JO - Clin Cardiol VL - 41 IS - 5 N2 - Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%-49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6-5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06-2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34-1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD. SN - 1932-8737 UR - https://www.unboundmedicine.com/medline/citation/29521447/Influence_of_symptom_typicality_for_predicting_MACE_in_patients_without_obstructive_coronary_artery_disease:_From_the_CONFIRM_Registry__Coronary_Computed_Tomography_Angiography_Evaluation_for_Clinical_Outcomes:_An_International_Multicenter_Registry__ L2 - https://doi.org/10.1002/clc.22940 DB - PRIME DP - Unbound Medicine ER -