Mortality Risk in Symptomatic Patients With Nonobstructive Coronary Artery Disease A Prospective 2-Center Study of 2,583 Patients Undergoing 64-Detector Row Coronary Computed Tomographic Angiography

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:58

Article

Lin, Fay Y.²  Shaw, Leslee J.³  Dunning, Allison M.²  Choi, Jin-Ho²  Weinsaft, Jonathan W.²  Koduru, Sunaina²  Gomez, Millie J.²  Delago, Augustin J.⁴  Callister, Tracy Q.⁵  Min, James K.¹ 

[1] Cedars Sinai Med Ctr, Cedars Sinai Heart Inst, Dept Med, Los Angeles, CA 90048 USA

[2] New York Presbyterian Hosp, Weill Cornell Med Coll, Div Cardiol, Dept Med, New York, NY USA

[3] Emory Univ, Sch Med, Atlanta, GA USA

[4] Capital Cardiol Associates, Albany, NY USA

[5] Tennessee Heart & Vasc Inst, Hendersonville, TN USA

关键词: atherosclerosis;    computed tomography;    coronary artery disease;    nonobstructive;    prognosis;   

DOI  :  10.1016/j.jacc.2010.11.078

来源: Elsevier

【 摘 要 】

Objectives We examined mortality risk in relation to extent and composition of nonobstructive plaques by 64-detector row coronary computed tomographic angiography (CCTA). Background The prognostic significance of nonobstructive coronary artery plaques by CCTA is poorly understood. Methods 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 stenosis 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 associated 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 nonobstructive 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 mortality 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 conventional clinical risk assessment. (J Am Coll Cardiol 2011; 58: 510-9) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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