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01-06-2014 | Original Article

Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease

Authors: Sana Shah, MD, Naveen Bellam, MD, Jonathon Leipsic, MD, Daniel S. Berman, MD, Arshed Quyyumi, MD, Jörg Hausleiter, MD, Stephan Achenbach, MD, Mouaz Al-Mallah, MD, Matthew J. Budoff, MD, Fillippo Cademartiri, MD, Tracy Q. Callister, MD, Hyuk-Jae Chang, MD, Benjamin J. W. Chow, MD, Ricardo C. Cury, MD, Augustin J. Delago, MD, Allison L. Dunning, MS, Gudrun M. Feuchtner, MD, Martin Hadamitzky, MD, Ronald P. Karlsberg, MD, Philipp A. Kaufmann, MD, Fay Y. Lin, MD, Kavitha M. Chinnaiyan, MD, Erica Maffei, MD, Gilbert L. Raff, MD, Todd C. Villines, MD, Millie J. Gomez, MD, James K. Min, MD, Leslee J. Shaw, PhD, for the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry) Investigators

Published in: Journal of Nuclear Cardiology | Issue 3/2014

Abstract

Background

Coronary artery calcium (CAC) is a well-established predictor of clinical outcomes for population screening. Limited evidence is available as to its predictive value in symptomatic patients without obstructive coronary artery disease (CAD). The aim of the current study was to assess the prognostic value of CAC scores among symptomatic patients with nonobstructive CAD.

Methods

From the COronary Computed Tomographic Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 7,200 symptomatic patients with nonobstructive CAD (<50% coronary stenosis) on coronary-computed tomographic angiography were prospectively enrolled and followed for a median of 2.1 years. Patients were categorized as without (0% stenosis) or with (>0% but <50% coronary stenosis) a luminal stenosis. CAC scores were calculated using the Agatston method. Univariable and multivariable Cox proportional hazard models were employed to estimate all-cause mortality and/or myocardial infarction (MI). Four-year death and death or MI rates were 1.9% and 3.3%.

Results

Of the 4,380 patients with no luminal stenosis, 86% had CAC scores of <10 while those with a luminal stenosis had more prevalent and extensive CAC with 31.9% having a CAC score of ≥100. Among patients with no luminal stenosis, CAC was not predictive of all-cause mortality (P = .44). However, among patients with a luminal stenosis, 4-year mortality rates ranged from 0.8% to 9.8% for CAC scores of 0 to ≥400 (P < .0001). The mortality hazard was 6.0 (P = .004) and 13.3 (P < .0001) for patients with a CAC score of 100-399 and ≥400. In patients with a luminal stenosis, CAC remained independently predictive in all-cause mortality (P < .0001) and death or MI (P < .0001) in multivariable models containing CAD risk factors and presenting symptoms.

Conclusions

CAC allows for the identification of those at an increased hazard for death or MI in symptomatic patients with nonobstructive disease. From the CONFIRM registry, the extent of CAC was an independent estimator of long-term prognosis among symptomatic patients with luminal stenosis and may further define risk and guide preventive strategies in patients with nonobstructive CAD.

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Title: Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease
Authors: Sana Shah, MD
Naveen Bellam, MD
Jonathon Leipsic, MD
Daniel S. Berman, MD
Arshed Quyyumi, MD
Jörg Hausleiter, MD
Stephan Achenbach, MD
Mouaz Al-Mallah, MD
Matthew J. Budoff, MD
Fillippo Cademartiri, MD
Tracy Q. Callister, MD
Hyuk-Jae Chang, MD
Benjamin J. W. Chow, MD
Ricardo C. Cury, MD
Augustin J. Delago, MD
Allison L. Dunning, MS
Gudrun M. Feuchtner, MD
Martin Hadamitzky, MD
Ronald P. Karlsberg, MD
Philipp A. Kaufmann, MD
Fay Y. Lin, MD
Kavitha M. Chinnaiyan, MD
Erica Maffei, MD
Gilbert L. Raff, MD
Todd C. Villines, MD
Millie J. Gomez, MD
James K. Min, MD
Leslee J. Shaw, PhD
for the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry) Investigators
Publication date: 01-06-2014
Publisher: Springer US
Published in: Journal of Nuclear Cardiology / Issue 3/2014
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-014-9865-9

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