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.
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.
Authors: Thomas M Maddox; Maggie A Stanislawski; Gary K Grunwald; Steven M Bradley; P Michael Ho; Thomas T Tsai; Manesh R Patel; Amneet Sandhu; Javier Valle; David J Magid; Benjamin Leon; Deepak L Bhatt; Stephan D Fihn; John S Rumsfeld Journal: JAMA Date: 2014-11-05 Impact factor: 56.272
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Authors: Hye Rin Kim; Seung Min Yoo; Ji Young Rho; Hwa Yeon Lee; Charles S White Journal: Int J Cardiovasc Imaging Date: 2014-04-01 Impact factor: 2.357
Authors: Sana Shah; Naveen Bellam; Jonathon Leipsic; Daniel S Berman; Arshed Quyyumi; Jörg Hausleiter; Stephan Achenbach; Mouaz Al-Mallah; Matthew J Budoff; Fillippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Benjamin J W Chow; Ricardo C Cury; Augustin J Delago; Allison L Dunning; Gudrun M Feuchtner; Martin Hadamitzky; Ronald P Karlsberg; Philipp A Kaufmann; Fay Y Lin; Kavitha M Chinnaiyan; Erica Maffei; Gilbert L Raff; Todd C Villines; Millie J Gomez; James K Min; Leslee J Shaw Journal: J Nucl Cardiol Date: 2014-03-29 Impact factor: 5.952
Authors: S Divakaran; M K Cheezum; E A Hulten; M S Bittencourt; M G Silverman; K Nasir; R Blankstein Journal: Br J Radiol Date: 2014-12-12 Impact factor: 3.039