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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Prognostic Impact of Nonobstructive Coronary Artery Disease Detected by Coronary Computed Tomographic Angiography

Daniel Košuta1,2, Borut Jug1,2, Zlatko Fras1,2

  • 1Department of Vascular Diseases, 364687Division of Internal Medicine, University Medical Centre of Ljubljana, Slovenia.

Angiology
|March 19, 2021
PubMed

Insights

Nonobstructive coronary artery disease (CAD) found on coronary computed tomographic angiography (CCTA) doubles the risk of cardiac events. This finding highlights the prognostic significance of even minimal plaque burden in patients presenting with chest pain.

Area of Science:

  • Cardiovascular Imaging
  • Preventive Cardiology
  • Clinical Prognosis

Background:

  • Coronary computed tomographic angiography (CCTA) is increasingly used to evaluate chest pain.
  • The prognostic implications of nonobstructive coronary artery disease (CAD) detected by CCTA require further elucidation.

Purpose of the Study:

  • To assess the prognostic impact of nonobstructive CAD identified on CCTA.
  • To compare cardiovascular event rates across groups with no CAD, nonobstructive CAD, and obstructive CAD.

Main Methods:

  • Retrospective review of 989 patients undergoing CCTA between 2010-2016.
  • Patients categorized into no CAD, nonobstructive CAD (<50% stenosis), and obstructive CAD (≥50% stenosis) groups.
  • Primary outcome: composite of death, myocardial infarction, unstable angina, and late revascularization.

Main Results:

  • Nonobstructive CAD (9% event rate) and obstructive CAD (16% event rate) were associated with significantly higher event rates compared to no CAD (7% event rate; P < .001).
  • Both nonobstructive and obstructive CAD independently predicted adverse events (HR 2.33 and 4.02, respectively).
  • Nonobstructive CAD demonstrated a 2-fold increased risk of coronary events versus no CAD.

Conclusions:

  • Nonobstructive CAD detected by CCTA carries significant prognostic value.
  • Patients with nonobstructive CAD have a substantially elevated risk of future coronary events.
  • CCTA findings of nonobstructive CAD warrant careful consideration in risk stratification for chest pain patients.

Keywords:
coronary artery diseasecoronary computed tomographic angiographyprognosis

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