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Prognostic and clinical correlates of angiographically diffuse non-obstructive coronary lesions
R Bigi1, L Cortigiani, P Colombo
1CNR Clinical Physiology Institute, Section of Milan, Milan, Italy. ifcnig@tin.it
Insights
The angiographic extent score effectively predicts adverse cardiovascular events in patients with non-obstructive coronary artery disease. This score offers valuable prognostic information beyond traditional risk factors, aiding in targeted preventive strategies.
Area of Science:
- Cardiology
- Vascular Biology
- Preventive Medicine
Background:
- Diffuse non-obstructive coronary artery lesions represent a significant challenge in cardiovascular risk assessment.
- Traditional methods often underestimate the prognostic implications of widespread coronary atherosclerosis.
Purpose of the Study:
- To prospectively evaluate the clinical and prognostic significance of angiographically determined diffuse non-obstructive coronary lesions.
- To identify predictors of adverse outcomes in patients with such lesions.
Main Methods:
- A cohort of 228 clinically stable patients underwent prospective follow-up for major adverse cardiovascular events.
- Angiographic vessel and extent scores were calculated, and their association with outcomes was analyzed using Cox proportional hazard models.
- Clinical variables including age, sex, diabetes, and hypertension were also assessed.
Main Results:
- The extent score independently predicted adverse outcomes, providing significant additional prognostic information (gain in chi2 = 7, p < 0.01).
- Age and diabetes were clinical markers associated with a higher extent score.
- While a vessel score of 3 indicated worse survival, the extent score effectively discriminated risk across all vessel score groups.
Conclusions:
- The angiographic extent score is a potent marker of adverse cardiovascular events, independent of lesion severity or number.
- This score may bridge the gap between clinical risk profiles and the extent of coronary atherosclerosis.
- The extent score holds clinical value for guiding aggressive preventive interventions in at-risk populations.
Objective:
To make a prospective assessment of the clinical and prognostic correlates of angiographically diffuse non-obstructive coronary lesions.
Design:
Angiographic vessel and extent scores were calculated in 228 clinically stable patients (mean (SD) age, 60 (11) years; 43 women, 185 men) undergoing prospective follow up for the composite end point of death and myocardial infarction. The effect on outcome of clinical variables (age, sex, previous myocardial infarction, diabetes mellitus, smoking habit, systemic hypertension, hypercholesterolaemia, ejection fraction) and angiographic variables (vessel and extent score) was evaluated by Cox's proportion hazard model.
Results:
The vessel score was 3 in 34 patients (15%), 2 in 78 (34%), 1 in 87 (38%), and 0 in 29 (13%). Median extent score was 60 (range 6-110; first quartile 40, third quartile 70). Forty one events (nine deaths and 32 myocardial infarcts) occurred over a median follow up period of 30 months. Age and extent score were the only multivariate predictors of outcome, but the latter provided 28% additional prognostic information after adjustment for the most predictive variables (gain in chi2 = 7, p < 0.01). A vessel score of 3 was associated with worse survival, while no significant discrimination was possible among the other groups. However, assignment of patients to two groups according to an ROC curve derived cut off value for the extent score made it possible to obtain significant discrimination of survival even in cases with vessel scores of 0 to 2. Age and diabetes were clinical markers of a higher extent score.
Conclusions:
The angiographic extent score is a powerful marker of adverse outcome independent of severity and the number of flow limiting coronary lesions, and may reflect the link between clinical risk profile and diffusion of coronary atherosclerosis. Thus it should be of clinical value for targeting aggressive preventive measures.