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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Mortality incidence of patients with non-obstructive coronary artery disease diagnosed by computed tomography
Naser Ahmadi1, Vahid Nabavi, Fereshteh Hajsadeghi
1Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California, USA.
Insights
In symptomatic patients with nonobstructive coronary artery disease (CAD), noncalcified and mixed plaques significantly increase mortality risk. Plaque type, not just stenosis, is crucial for predicting outcomes in CAD patients.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Previous studies linked symptomatic coronary artery disease (CAD) event-free survival to obstructive plaque severity.
- Nonobstructive CAD (1-49% stenosis) outcomes based on plaque morphology were not well-defined.
Purpose of the Study:
- To evaluate clinical outcomes in symptomatic patients with nonobstructive CAD.
- To assess the impact of coronary plaque morphology (noncalcified, mixed, calcified) on all-cause mortality.
Main Methods:
- Prospective follow-up of 1,102 symptomatic patients with nonobstructive CAD (stenosis 1-49%) diagnosed via computed tomographic angiography.
- Analysis of coronary plaque morphology and coronary artery calcium scoring.
- Multivariate Cox proportional-hazards models to predict all-cause mortality.
Main Results:
- The overall death rate in nonobstructive CAD patients was 3.1%.
- Death rates increased significantly from calcified (1.4%) to mixed (3.3%) to noncalcified plaques (9.6%).
- Noncalcified and mixed plaques were independent predictors of all-cause mortality (HR 7.4 and 3.2, respectively) compared to calcified plaques.
Conclusions:
- Noncalcified and mixed coronary plaques in patients with nonobstructive CAD provide significant prognostic information for all-cause mortality.
- Plaque morphology is a critical factor in risk stratification for symptomatic patients with nonobstructive CAD.
- These findings aid in refining risk prediction beyond traditional stenosis severity.
Abstract:
It was previously reported that event-free survival rates of symptomatic patients with coronary artery disease (CAD) diagnosed by computed tomographic angiography decreased incrementally from normal coronary arteries to obstructive CAD. The aim of this study was to investigate the clinical outcomes of symptomatic patients with nonobstructive CAD with luminal stenoses of 1% to 49% on the basis of coronary plaque morphology in an outpatient setting. Among 3,499 consecutive symptomatic subjects who underwent computed tomographic angiography, 1,102 subjects with nonobstructive CAD (mean age 59 ± 14 years, 69.9% men) were prospectively followed for a mean of 78 ± 12 months. Coronary plaques were defined as noncalcified, mixed, and calcified per patient. Multivariate Cox proportional-hazards models were developed to predict all-cause mortality. The death rate of patients with nonobstructive CAD was 3.1% (34 deaths). The death rate increased incrementally from calcified plaque (1.4%) to mixed plaque (3.3%) to noncalcified plaque (9.6%), as well as from single- to triple-vessel disease (p <0.001). In subjects with mixed or calcified plaques, the death rate increased with the severity of coronary artery calcium from 1 to 9 to ≥ 400. The risk-adjusted hazard ratios of all-cause mortality in patients with nonobstructive CAD were 3.2 (95% confidence interval 1.3 to 8.0, p = 0.001) for mixed plaques and 7.4 (95% confidence interval 2.7 to 20.1, p = 0.0001) for noncalcified plaques compared with calcified plaques. The areas under the receiver-operating characteristic curve to predict all-cause mortality were 0.75 for mixed and 0.86 for noncalcified coronary lesions. In conclusion, this study demonstrates that the presence of noncalcified and mixed coronary plaques provided incremental value in predicting all-cause mortality in symptomatic subjects with nonobstructive CAD independent of age, gender, and conventional risk factors.
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