Document Detail

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.
MedLine Citation:
PMID:  21777749     Owner:  NLM     Status:  In-Data-Review    
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.
Fay Y Lin; Leslee J Shaw; Allison M Dunning; Troy M Labounty; Jin-Ho Choi; Jonathan W Weinsaft; Sunaina Koduru; Millie J Gomez; Augustin J Delago; Tracy Q Callister; Daniel S Berman; James K Min
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  58     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  510-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
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