Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA.
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2020 May 1;21(5):479-488. doi: 10.1093/ehjci/jez322.
In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent.
Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3-4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3-2.2) and 1.4 (95% CI 1.1-1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004).
Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.
在无阻塞性冠状动脉疾病（CAD）的患者中，我们研究了危险因素和动脉粥样硬化程度的预后价值。
本研究纳入了长期 CONFIRM 注册研究中无既往 CAD 且无阻塞性（≥50%）狭窄的患者。在正常冠状动脉计算机断层扫描血管造影（CCTA）（N=1849）和非阻塞性 CAD 组（N=1698）中，使用 Cox 模型评估了传统临床危险因素和动脉粥样硬化程度（节段受累评分，SIS）的预后价值。主要不良心脏事件（MACE）定义为全因死亡率、非致死性心肌梗死或晚期血运重建。共纳入 3547 例患者（年龄 57.9±12.1 岁，57.8%为男性），随访 5.4 年期间发生 460 例 MACE。年龄、体重指数、高血压和糖尿病是与 MACE 风险增加相关的临床变量，但 CCTA 定义的动脉粥样硬化程度的风险更高；SIS>5 的调整后的危险比（HR）为 3.4（95%置信区间 [CI] 2.3-4.9），而糖尿病和高血压的 HR 分别为 1.7（95% CI 1.3-2.2）和 1.4（95% CI 1.1-1.7）。将血运重建作为终点排除后，结果并未改变。在正常 CCTA 中，存在≥1 个传统危险因素并不会使预后恶化（对数秩检验 P=0.248），而非阻塞性 CAD 则会（对数秩检验 P=0.025）。在校正 SIS 后，高血压和糖尿病可预测非阻塞性 CAD 患者的 MACE 风险，而在无 CAD 时，糖尿病不会增加风险（P 交互=0.004）。
在无阻塞性 CAD 的患者中，CAD 的程度比传统心血管危险因素为 MACE 提供了更多的预后信息。还观察到危险因素和 CAD 负担之间存在交互作用，表明两者具有协同作用。
