It was previously reported that event-free survival rates of symptomatic patients
with coronary artery disease (CAD) diagnosed by computed tomographic angiography decreased
incrementally from normal coronary arteries to obstructive CAD. The aim of this study
was to investigate the clinical outcomes of symptomatic patients with nonobstructive
CAD with luminal stenoses of 1% to 49% on the basis of coronary plaque morphology
in an outpatient setting. Among 3,499 consecutive symptomatic subjects who underwent
computed tomographic angiography, 1,102 subjects with nonobstructive CAD (mean age
59 ± 14 years, 69.9% men) were prospectively followed for a mean of 78 ± 12 months.
Coronary plaques were defined as noncalcified, mixed, and calcified per patient. Multivariate
Cox proportional-hazards models were developed to predict all-cause mortality. The
death rate of patients with nonobstructive CAD was 3.1% (34 deaths). The death rate
increased incrementally from calcified plaque (1.4%) to mixed plaque (3.3%) to noncalcified
plaque (9.6%), as well as from single- to triple-vessel disease (p <0.001). In subjects
with mixed or calcified plaques, the death rate increased with the severity of coronary
artery calcium from 1 to 9 to ≥400. The risk-adjusted hazard ratios of all-cause mortality
in patients with nonobstructive CAD were 3.2 (95% confidence interval 1.3 to 8.0,
p = 0.001) for mixed plaques and 7.4 (95% confidence interval 2.7 to 20.1, p = 0.0001)
for noncalcified plaques compared with calcified plaques. The areas under the receiver-operating
characteristic curve to predict all-cause mortality were 0.75 for mixed and 0.86 for
noncalcified coronary lesions. In conclusion, this study demonstrates that the presence
of noncalcified and mixed coronary plaques provided incremental value in predicting
all-cause mortality in symptomatic subjects with nonobstructive CAD independent of
age, gender, and conventional risk factors.
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Article Info
Publication History
Accepted:
August 21,
2010
Received in revised form:
August 21,
2010
Received:
May 25,
2010
Footnotes
Dr. Budoff is a member of the speaker's bureau for General Electric (Milwaukee, Wisconsin).
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
