Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events

Marcio Sommer Bittencourt, Edward Hulten, Brian Ghoshhajra, Daniel O'Leary, Mitalee P. Christman, Philip Montana, Quynh A. Truong, Michael Steigner, Venkatesh L. Murthy, Frank J. Rybicki, Khurram Nasir, Luis Henrique W Gowdak, Jon Hainer, Thomas J. Brady, Marcelo F. Di Carli, Udo Hoffmann, Suhny Abbara, Ron Blankstein

Research output: Contribution to journalArticle

168 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)282-291
Number of pages10
JournalCirculation: Cardiovascular Imaging
Volume7
Issue number2
DOIs
StatePublished - 2014

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Coronary Artery Disease
Confidence Intervals
Myocardial Infarction
Computed Tomography Angiography
Mortality

Keywords

  • Coronary Artery Disease
  • Prognosis
  • Risk Assessment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. / Bittencourt, Marcio Sommer; Hulten, Edward; Ghoshhajra, Brian; O'Leary, Daniel; Christman, Mitalee P.; Montana, Philip; Truong, Quynh A.; Steigner, Michael; Murthy, Venkatesh L.; Rybicki, Frank J.; Nasir, Khurram; Gowdak, Luis Henrique W; Hainer, Jon; Brady, Thomas J.; Di Carli, Marcelo F.; Hoffmann, Udo; Abbara, Suhny; Blankstein, Ron.

In: Circulation: Cardiovascular Imaging, Vol. 7, No. 2, 2014, p. 282-291.

Research output: Contribution to journalArticle

Bittencourt, MS, Hulten, E, Ghoshhajra, B, O'Leary, D, Christman, MP, Montana, P, Truong, QA, Steigner, M, Murthy, VL, Rybicki, FJ, Nasir, K, Gowdak, LHW, Hainer, J, Brady, TJ, Di Carli, MF, Hoffmann, U, Abbara, S & Blankstein, R 2014, 'Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events', Circulation: Cardiovascular Imaging, vol. 7, no. 2, pp. 282-291. https://doi.org/10.1161/CIRCIMAGING.113.001047
Bittencourt, Marcio Sommer ; Hulten, Edward ; Ghoshhajra, Brian ; O'Leary, Daniel ; Christman, Mitalee P. ; Montana, Philip ; Truong, Quynh A. ; Steigner, Michael ; Murthy, Venkatesh L. ; Rybicki, Frank J. ; Nasir, Khurram ; Gowdak, Luis Henrique W ; Hainer, Jon ; Brady, Thomas J. ; Di Carli, Marcelo F. ; Hoffmann, Udo ; Abbara, Suhny ; Blankstein, Ron. / Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. In: Circulation: Cardiovascular Imaging. 2014 ; Vol. 7, No. 2. pp. 282-291.
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abstract = "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.",
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AU - O'Leary, Daniel

AU - Christman, Mitalee P.

AU - Montana, Philip

AU - Truong, Quynh A.

AU - Steigner, Michael

AU - Murthy, Venkatesh L.

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