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Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy.
J Cardiovasc Comput Tomogr. 2018 May - Jun; 12(3):231-237.JC

Abstract

BACKGROUND

The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA).

METHODS

CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque.

RESULTS

Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components.

CONCLUSION

The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.

Authors+Show Affiliations

St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada.St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada.St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada.Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA.Cardiovascular Imaging Center, IRCCS SDN Foundation, Naples, Italy.Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.Busan University Hospital, Busan, South Korea.Seoul National University Bundang Hospital, South Korea.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil.Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.Seoul National University College of Medicine, Seoul National University Hospital, South Korea.Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.National Health Insurance Service Ilsan Hospital, South Korea.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA.Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA.Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

29802032

Citation

Weir-McCall, Jonathan R., et al. "Impact of Non-obstructive Left Main Disease On the Progression of Coronary Artery Disease: a PARADIGM Substudy." Journal of Cardiovascular Computed Tomography, vol. 12, no. 3, 2018, pp. 231-237.
Weir-McCall JR, Blanke P, Sellers SL, et al. Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy. J Cardiovasc Comput Tomogr. 2018;12(3):231-237.
Weir-McCall, J. R., Blanke, P., Sellers, S. L., Ahmadi, A. A., Andreini, D., Budoff, M. J., Cademartiri, F., Chinnaiyan, K., Choi, J. H., Chun, E. J., Conte, E., Gottlieb, I., Hadamitzky, M., Kim, Y. J., Lee, B. K., Lee, S. E., Maffei, E., Marques, H., Pontone, G., ... Leipsic, J. A. (2018). Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy. Journal of Cardiovascular Computed Tomography, 12(3), 231-237. https://doi.org/10.1016/j.jcct.2018.05.011
Weir-McCall JR, et al. Impact of Non-obstructive Left Main Disease On the Progression of Coronary Artery Disease: a PARADIGM Substudy. J Cardiovasc Comput Tomogr. 2018 May - Jun;12(3):231-237. PubMed PMID: 29802032.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy. AU - Weir-McCall,Jonathan R, AU - Blanke,Philipp, AU - Sellers,Stephanie L, AU - Ahmadi,Amir A, AU - Andreini,Daniele, AU - Budoff,Matthew J, AU - Cademartiri,Filippo, AU - Chinnaiyan,Kavitha, AU - Choi,Jung Hyun, AU - Chun,Eun Ju, AU - Conte,Edoardo, AU - Gottlieb,Ilan, AU - Hadamitzky,Martin, AU - Kim,Yong Jin, AU - Lee,Byoung Kwon, AU - Lee,Sang-Eun, AU - Maffei,Erica, AU - Marques,Hugo, AU - Pontone,Gianluca, AU - Raff,Gilbert L, AU - Shin,Sanghoon, AU - Sung,Ji Min, AU - Stone,Peter, AU - Samady,Habib, AU - Virmani,Renu, AU - Narula,Jagat, AU - Berman,Daniel S, AU - Shaw,Leslee J, AU - Bax,Jeroen J, AU - Lin,Fay Y, AU - Min,James K, AU - Chang,Hyuk-Jae, AU - Leipsic,Jonathon A, Y1 - 2018/05/19/ PY - 2018/04/25/received PY - 2018/05/10/revised PY - 2018/05/13/accepted PY - 2018/5/29/pubmed PY - 2018/8/28/medline PY - 2018/5/27/entrez KW - Coronary computed tomography angiography KW - Left main coronary artery disease KW - Natural history SP - 231 EP - 237 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 12 IS - 3 N2 - BACKGROUND: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). METHODS: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. RESULTS: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. CONCLUSION: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/29802032/Impact_of_Non_obstructive_left_main_disease_on_the_progression_of_coronary_artery_disease:_A_PARADIGM_substudy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(18)30114-X DB - PRIME DP - Unbound Medicine ER -