Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART)Program

J. Antonio Gutierrez, Deepak L. Bhatt, Subhash Banerjee, Thomas J. Glorioso, Kevin P. Josey, Rajesh V. Swaminathan, Thomas M. Maddox, Ehrin J. Armstrong, Claire Duvernoy, Stephen W. Waldo, Sunil V. Rao

Research output: Contribution to journalArticle

Abstract

We sought to determine the risk of obstructive coronary artery disease (oCAD)associated with noncoronary atherosclerosis (cerebrovascular disease [CVD]or peripheral arterial disease [PAD])and major adverse cardiac events following percutaneous coronary intervention (PCI). Methods: Rates of the angiographic end point of oCAD were compared among patients with and without noncoronary atherosclerosis undergoing coronary angiography within the Veterans Health Administration between October 2007 and August 2015. The primary angiographic end point of oCAD was defined as left main stenosis ≥50% or any stenosis ≥70% in 1, 2, or 3 vessels. In patients who proceeded to PCI, the rate of the composite clinical end point of death, myocardial infarction, or stroke was compared among those with concomitant noncoronary atherosclerosis (CVD, PAD, or CVD + PAD)versus isolated CAD. Results: Among 233,353 patients undergoing angiography, 9.6% had CVD, 12.4% had PAD, and 6.1% had CVD + PAD. Rates of oCAD were 57.9% for neither CVD nor PAD, 66.4% for CVD, 73.6% for PAD, and 80.9% for CVD + PAD. Compared with patients without noncoronary atherosclerosis, the adjusted risk of oCAD with CVD, PAD, or CVD + PAD was 1.03 (95% CI 1.02-1.04), 1.10 (95% CI 1.09-1.11), and 1.12 (95% CI 1.11-1.13), respectively. In patients who underwent PCI, the adjusted hazard for death, myocardial infarction, or stroke among those with CVD, PAD, or CVD + PAD was 1.36 (95% CI 1.26-1.45), 1.53 (95% CI 1.45-1.62), and 1.72 (95% CI 1.59-1.86), respectively. Conclusions: In patients undergoing coronary angiography, noncoronary atherosclerosis was associated with increased burden of oCAD and adverse events post-PCI.

Original languageEnglish (US)
Pages (from-to)47-56
Number of pages10
JournalAmerican Heart Journal
Volume213
DOIs
StatePublished - Jul 1 2019

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Cerebrovascular Disorders
Peripheral Arterial Disease
Veterans
Coronary Artery Disease
Atherosclerosis
Percutaneous Coronary Intervention
Coronary Angiography
Pathologic Constriction
Stroke
Myocardial Infarction
Veterans Health
United States Department of Veterans Affairs
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis : Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART)Program. / Gutierrez, J. Antonio; Bhatt, Deepak L.; Banerjee, Subhash; Glorioso, Thomas J.; Josey, Kevin P.; Swaminathan, Rajesh V.; Maddox, Thomas M.; Armstrong, Ehrin J.; Duvernoy, Claire; Waldo, Stephen W.; Rao, Sunil V.

In: American Heart Journal, Vol. 213, 01.07.2019, p. 47-56.

Research output: Contribution to journalArticle

Gutierrez, J. Antonio ; Bhatt, Deepak L. ; Banerjee, Subhash ; Glorioso, Thomas J. ; Josey, Kevin P. ; Swaminathan, Rajesh V. ; Maddox, Thomas M. ; Armstrong, Ehrin J. ; Duvernoy, Claire ; Waldo, Stephen W. ; Rao, Sunil V. / Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis : Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART)Program. In: American Heart Journal. 2019 ; Vol. 213. pp. 47-56.
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title = "Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART)Program",
abstract = "We sought to determine the risk of obstructive coronary artery disease (oCAD)associated with noncoronary atherosclerosis (cerebrovascular disease [CVD]or peripheral arterial disease [PAD])and major adverse cardiac events following percutaneous coronary intervention (PCI). Methods: Rates of the angiographic end point of oCAD were compared among patients with and without noncoronary atherosclerosis undergoing coronary angiography within the Veterans Health Administration between October 2007 and August 2015. The primary angiographic end point of oCAD was defined as left main stenosis ≥50{\%} or any stenosis ≥70{\%} in 1, 2, or 3 vessels. In patients who proceeded to PCI, the rate of the composite clinical end point of death, myocardial infarction, or stroke was compared among those with concomitant noncoronary atherosclerosis (CVD, PAD, or CVD + PAD)versus isolated CAD. Results: Among 233,353 patients undergoing angiography, 9.6{\%} had CVD, 12.4{\%} had PAD, and 6.1{\%} had CVD + PAD. Rates of oCAD were 57.9{\%} for neither CVD nor PAD, 66.4{\%} for CVD, 73.6{\%} for PAD, and 80.9{\%} for CVD + PAD. Compared with patients without noncoronary atherosclerosis, the adjusted risk of oCAD with CVD, PAD, or CVD + PAD was 1.03 (95{\%} CI 1.02-1.04), 1.10 (95{\%} CI 1.09-1.11), and 1.12 (95{\%} CI 1.11-1.13), respectively. In patients who underwent PCI, the adjusted hazard for death, myocardial infarction, or stroke among those with CVD, PAD, or CVD + PAD was 1.36 (95{\%} CI 1.26-1.45), 1.53 (95{\%} CI 1.45-1.62), and 1.72 (95{\%} CI 1.59-1.86), respectively. Conclusions: In patients undergoing coronary angiography, noncoronary atherosclerosis was associated with increased burden of oCAD and adverse events post-PCI.",
author = "Gutierrez, {J. Antonio} and Bhatt, {Deepak L.} and Subhash Banerjee and Glorioso, {Thomas J.} and Josey, {Kevin P.} and Swaminathan, {Rajesh V.} and Maddox, {Thomas M.} and Armstrong, {Ehrin J.} and Claire Duvernoy and Waldo, {Stephen W.} and Rao, {Sunil V.}",
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T1 - Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis

T2 - Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART)Program

AU - Gutierrez, J. Antonio

AU - Bhatt, Deepak L.

AU - Banerjee, Subhash

AU - Glorioso, Thomas J.

AU - Josey, Kevin P.

AU - Swaminathan, Rajesh V.

AU - Maddox, Thomas M.

AU - Armstrong, Ehrin J.

AU - Duvernoy, Claire

AU - Waldo, Stephen W.

AU - Rao, Sunil V.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - We sought to determine the risk of obstructive coronary artery disease (oCAD)associated with noncoronary atherosclerosis (cerebrovascular disease [CVD]or peripheral arterial disease [PAD])and major adverse cardiac events following percutaneous coronary intervention (PCI). Methods: Rates of the angiographic end point of oCAD were compared among patients with and without noncoronary atherosclerosis undergoing coronary angiography within the Veterans Health Administration between October 2007 and August 2015. The primary angiographic end point of oCAD was defined as left main stenosis ≥50% or any stenosis ≥70% in 1, 2, or 3 vessels. In patients who proceeded to PCI, the rate of the composite clinical end point of death, myocardial infarction, or stroke was compared among those with concomitant noncoronary atherosclerosis (CVD, PAD, or CVD + PAD)versus isolated CAD. Results: Among 233,353 patients undergoing angiography, 9.6% had CVD, 12.4% had PAD, and 6.1% had CVD + PAD. Rates of oCAD were 57.9% for neither CVD nor PAD, 66.4% for CVD, 73.6% for PAD, and 80.9% for CVD + PAD. Compared with patients without noncoronary atherosclerosis, the adjusted risk of oCAD with CVD, PAD, or CVD + PAD was 1.03 (95% CI 1.02-1.04), 1.10 (95% CI 1.09-1.11), and 1.12 (95% CI 1.11-1.13), respectively. In patients who underwent PCI, the adjusted hazard for death, myocardial infarction, or stroke among those with CVD, PAD, or CVD + PAD was 1.36 (95% CI 1.26-1.45), 1.53 (95% CI 1.45-1.62), and 1.72 (95% CI 1.59-1.86), respectively. Conclusions: In patients undergoing coronary angiography, noncoronary atherosclerosis was associated with increased burden of oCAD and adverse events post-PCI.

AB - We sought to determine the risk of obstructive coronary artery disease (oCAD)associated with noncoronary atherosclerosis (cerebrovascular disease [CVD]or peripheral arterial disease [PAD])and major adverse cardiac events following percutaneous coronary intervention (PCI). Methods: Rates of the angiographic end point of oCAD were compared among patients with and without noncoronary atherosclerosis undergoing coronary angiography within the Veterans Health Administration between October 2007 and August 2015. The primary angiographic end point of oCAD was defined as left main stenosis ≥50% or any stenosis ≥70% in 1, 2, or 3 vessels. In patients who proceeded to PCI, the rate of the composite clinical end point of death, myocardial infarction, or stroke was compared among those with concomitant noncoronary atherosclerosis (CVD, PAD, or CVD + PAD)versus isolated CAD. Results: Among 233,353 patients undergoing angiography, 9.6% had CVD, 12.4% had PAD, and 6.1% had CVD + PAD. Rates of oCAD were 57.9% for neither CVD nor PAD, 66.4% for CVD, 73.6% for PAD, and 80.9% for CVD + PAD. Compared with patients without noncoronary atherosclerosis, the adjusted risk of oCAD with CVD, PAD, or CVD + PAD was 1.03 (95% CI 1.02-1.04), 1.10 (95% CI 1.09-1.11), and 1.12 (95% CI 1.11-1.13), respectively. In patients who underwent PCI, the adjusted hazard for death, myocardial infarction, or stroke among those with CVD, PAD, or CVD + PAD was 1.36 (95% CI 1.26-1.45), 1.53 (95% CI 1.45-1.62), and 1.72 (95% CI 1.59-1.86), respectively. Conclusions: In patients undergoing coronary angiography, noncoronary atherosclerosis was associated with increased burden of oCAD and adverse events post-PCI.

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