Prognostic Value of Nonobstructive and Obstructive Coronary Artery Disease Detected by Coronary Computed Tomography Angiography to Identify Cardiovascular Events

被引：306

作者：

Bittencourt, Marcio Sommer ^{[1
,2
,3
]}

Hulten, Edward ^{[1
,2
]}

Ghoshhajra, Brian ^{[4
]}

O'Leary, Daniel ^{[1
,2
]}

Christman, Mitalee P. ^{[1
,2
]}

Montana, Philip ^{[1
,2
]}

Truong, Quynh A. ^{[5
]}

Steigner, Michael ^{[1
,2
]}

Murthy, Venkatesh L. ^{[6
]}

Rybicki, Frank J. ^{[1
,2
]}

Nasir, Khurram ^{[7
,8
,9
,10
,11
]}

Gowdak, Luis Henrique W. ^{[3
]}

Hainer, Jon ^{[1
,2
]}

Brady, Thomas J. ^{[4
]}

Di Carli, Marcelo F. ^{[1
,2
]}

Hoffmann, Udo ^{[4
]}

Abbara, Suhny ^{[4
]}

Blankstein, Ron ^{[1
,2
]}

机构：

[1] Harvard Univ, Brigham & Womens Hosp, Noninvas Cardiovasc Imaging Program, Dept Med,Med Sch, Boston, MA 02115 USA

[2] Harvard Univ, Brigham & Womens Hosp, Noninvas Cardiovasc Imaging Program, Dept Radiol,Med Sch, Boston, MA 02115 USA

[3] Univ Sao Paulo, Heart Inst InCor, Sao Paulo, Brazil

[4] Harvard Univ, Sch Med, Dept Radiol,Massachusetts Gen Hosp, Cardiac MR PET CT Program,Div Cardiac Imaging, Boston, MA 02115 USA

[5] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Div Cardiol, Boston, MA USA

[6] Univ Michigan, Dept Med, Div Cardiovasc Med, Ann Arbor, MI 48109 USA

[7] Baptist Hlth South Florida, Ctr Prevent & Wellness Res, Miami Beach, FL USA

[8] Johns Hopkins Ciccarone Ctr Prevent Heart Dis, Baltimore, MD USA

[9] Baptist Hlth South Florida, Baptist Cardiovasc Inst, Miami, FL USA

[10] Florida Int Univ, Robert Stempel Coll Publ Hlth, Dept Epidemiol, Miami, FL 33199 USA

[11] Herbert Wertheim Coll Med, Dept Med, Miami, FL USA

来源：

CIRCULATION-CARDIOVASCULAR IMAGING | 2014年 / 7卷 / 02期

关键词：

risk assessment; prognosis; coronary artery disease; CT ANGIOGRAPHY; CLINICAL-OUTCOMES; SYMPTOMATIC PATIENTS; MORTALITY RISK; SEVERITY; PLAQUE; ATHEROSCLEROSIS; PREDICTION; REGISTRY; SCORE;

D O I：

10.1161/CIRCIMAGING.113.001047

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background- The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography. Methods and Results- All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (< 50% stenosis), or obstructive (>= 50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (<= 4 segments) or extensive (> 4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1-5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5-6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3-6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2-7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction. Conclusions- Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment.

引用

页码：282 / 291

页数：10

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