Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
Division of Internal Medicine, Department of Medicine, Creighton University, Omaha, Nebraska, USA.
Int J Cardiovasc Imaging. 2022 Mar;38(3):683-693. doi: 10.1007/s10554-021-02429-3. Epub 2021 Oct 10.
The presence of non-obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CTA) has been associated with the occurrence of major adverse cardiac events (MACE). However, factors associated with the development of MACE in symptomatic women with non-obstructive CAD on coronary CTA have not been fully elucidated. We sought to examine the influence of risk factors and coronary artery calcification on MACE in symptomatic women with non-obstructive CAD on coronary CTA. Women from PROMISE and SCOT-HEART trials with none or non-obstructive CAD on coronary CTA comprised the study cohort. Baseline characteristics and clinical presentation were assessed. Survival analysis using Kaplan-Meier curves was done to compare outcomes stratified by the atherosclerotic cardiovascular disease (ASCVD) risk score and the Agatston score. The primary endpoint was a composite of all-cause mortality, myocardial infarction, and revascularization. 2597 women had non-obstructive CAD or normal coronary CTA, with a median follow-up of 32 months. Compared to women without MACE, women with MACE had lower high-density lipoprotein cholesterol (HDL-C) levels and higher mean ASCVD risk scores. Further, women with non-obstructive CAD and ASCVD ≥ 7.5% had higher risk of MACE than those with ASCVD < 7.5% [3.2% vs. 1.1%, adjusted HR (aHR) of 3.1 (95% CI 1.32, 7.23), P-value 0.009]. The Agatston calcium score, on the other hand, was not independently associated with MACE among this population of symptomatic women. Symptomatic women with non-obstructive CAD on coronary CTA are at higher risk for MACE, with the ASCVD risk score being independently associated with the occurrence of adverse events.
冠状动脉计算机断层扫描血管造影（CTA）显示存在非阻塞性冠状动脉疾病（CAD）与主要不良心脏事件（MACE）的发生有关。然而，在冠状动脉 CTA 显示非阻塞性 CAD 的有症状女性中，与 MACE 发展相关的因素尚未完全阐明。我们旨在研究在冠状动脉 CTA 显示非阻塞性 CAD 的有症状女性中，危险因素和冠状动脉钙化对 MACE 的影响。本研究队列包括 PROMISE 和 SCOT-HEART 试验中冠状动脉 CTA 显示无 CAD 或非阻塞性 CAD 的女性。评估了基线特征和临床表现。使用 Kaplan-Meier 曲线进行生存分析，以比较按动脉粥样硬化性心血管疾病（ASCVD）风险评分和 Agatston 评分分层的结果。主要终点是全因死亡率、心肌梗死和血运重建的复合终点。2597 名女性有非阻塞性 CAD 或正常冠状动脉 CTA，中位随访时间为 32 个月。与无 MACE 的女性相比，有 MACE 的女性的高密度脂蛋白胆固醇（HDL-C）水平较低，平均 ASCVD 风险评分较高。此外，非阻塞性 CAD 且 ASCVD≥7.5%的女性发生 MACE 的风险高于 ASCVD<7.5%的女性[3.2%比 1.1%，调整后的 HR（aHR）为 3.1（95%CI 1.32，7.23），P 值为 0.009]。然而，在该有症状女性人群中，Agatston 钙评分与 MACE 之间并无独立相关性。冠状动脉 CTA 显示存在非阻塞性 CAD 的有症状女性发生 MACE 的风险较高，ASCVD 风险评分与不良事件的发生独立相关。
