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Published on: August 28, 2018
Prognostic value of non-obstructive coronary artery disease based on coronary computed tomography angiography in a
Zengfa Huang1, Xiaowei Chen1, Wanpeng Wang1
1Department of Radiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China.
Insights
Non-obstructive coronary artery disease (CAD) significantly increases the risk of all-cause death by 1.42-fold compared to no CAD. This finding highlights the clinical importance of non-obstructive CAD and warrants further research into interventions.
Area of Science:
- Cardiology
- Medical Imaging
- Public Health
Background:
- Coronary artery disease (CAD) is a major cause of mortality worldwide.
- The prognostic significance of non-obstructive CAD, often detected by coronary computed tomography angiography (CTA), remains under investigation.
- Understanding long-term outcomes for patients with varying degrees of CAD is crucial for risk stratification and management.
Purpose of the Study:
- To evaluate the long-term prognostic value of non-obstructive CAD in predicting all-cause mortality.
- To compare the risk of death among patients with no CAD, non-obstructive CAD, and obstructive CAD.
- To determine the clinical significance of non-obstructive CAD detected via coronary CTA.
Main Methods:
- Retrospective, observational, multicenter study involving 7320 patients with suspected CAD.
- Coronary CTA was used to categorize patients into no CAD, non-obstructive CAD, and obstructive CAD groups.
- All-cause mortality was tracked over a median follow-up of 8.0 years using multivariate Cox models and Kaplan-Meier survival analysis.
Main Results:
- Annualized mortality rates were 0.50% for no CAD, 1.31% for non-obstructive CAD, and 2.18% for obstructive CAD.
- Patients with non-obstructive CAD had a 1.42-fold increased risk of all-cause mortality (HR: 1.42; P=0.001) compared to those with no CAD.
- Obstructive CAD showed a 1.87-fold increased risk (HR: 1.87; P<0.001) compared to no CAD, with significant differences in cumulative events (P<0.001).
Conclusions:
- Non-obstructive CAD detected by coronary CTA is independently associated with a significantly increased long-term risk of all-cause mortality.
- These findings underscore the clinical relevance of non-obstructive CAD, challenging the notion that only obstructive lesions carry prognostic weight.
- Further research is warranted to explore interventions aimed at improving outcomes for patients with non-obstructive CAD.
Abstract:
This study investigates the long-term prognostic significance of non-obstructive coronary artery disease (CAD) in predicting the risk of all-cause death in a multicenter study. Three hospitals in Wuhan participated in this retrospective, observational, multicenter study of 7320 patients with suspected of having CAD and who underwent clinical coronary computed tomography angiography (CTA) from June 2011 to December 2015. According to coronary CTA, the extent of CAD was categorized as non-obstructive, obstructive, and no CAD. The primary outcome was all-cause mortality. A total of 611 patients experienced all-cause mortality with a median duration of 8.0 years (7.2-8.9). The annualized mortality rate was 0.50 (95% CI: 0.43-0.58), 1.31 (95% CI: 1.16-1.47), and 2.18 (95% CI: 1.93-2.46) for the no CAD, non-obstructive CAD, and obstructive CAD, respectively. There was a significant association between the classification and the increased cumulative events, as shown by the Kaplan-Meier survival curve (P < 0.001). The multivariate Cox model showed that the hazard ratios (HR) for predicting all-cause mortality from 1.42 (95% CI: 1.15-1.75, P = 0.001) in non-obstructive CAD to 1.87 (95% CI: 1.50-2.33, P < 0.001) in obstructive CAD compared with no CAD. At 8-year follow-up, patients with non-obstructive CAD detected by coronary CTA had a 1.42-fold increased risk of all-cause mortality compared to patients without evidence of CAD. Thus, these findings suggest that non-obstructive CAD is clinically significant and that further investigation of interventions to improve the prognosis of these patients is warranted.
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