Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis

Patients with obstructive coronary artery disease (CAD) are at high risk for cardiovascular disease (CVD) events. However, it remains unclear whether the high risk is due to high atherosclerotic disease burden or if presence of stenosis has independent predictive value. The purpose of this study was...

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Veröffentlicht in:Journal of the American College of Cardiology Jg. 76; H. 24; S. 2803
Hauptverfasser: Mortensen, Martin Bødtker, Dzaye, Omar, Steffensen, Flemming Hald, Bøtker, Hans Erik, Jensen, Jesper Møller, Rønnow Sand, Niels Peter, Kragholm, Kristian Hay, Sørensen, Henrik Toft, Leipsic, Jonathon, Mæng, Michael, Blaha, Michael J, Nørgaard, Bjarne Linde
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 15.12.2020
Schlagworte:
Aged
Coronary Angiography
Coronary Artery Disease - complications
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - mortality
Coronary Occlusion - complications
Coronary Occlusion - diagnostic imaging
Coronary Occlusion - mortality
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Plaque, Atherosclerotic - complications
Plaque, Atherosclerotic - diagnostic imaging
Plaque, Atherosclerotic - mortality
Registries
Denmark
coronary artery disease
epidemiology
cohort study
coronary artery calcium
cardiovascular disease risk
obstructive vessel disease
computed tomography angiography
ISSN:1558-3597, 1558-3597
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Zusammenfassung:Patients with obstructive coronary artery disease (CAD) are at high risk for cardiovascular disease (CVD) events. However, it remains unclear whether the high risk is due to high atherosclerotic disease burden or if presence of stenosis has independent predictive value. The purpose of this study was to evaluate if obstructive CAD provides predictive value beyond its association with total calcified atherosclerotic plaque burden as assessed by coronary artery calcium (CAC). Among 23,759 symptomatic patients from the Western Denmark Heart Registry who underwent diagnostic computed tomography angiography (CTA), we assessed the risk of major CVD (myocardial infarction, stroke, and all-cause death) stratified by CAC burden and number of vessels with obstructive disease. During a median follow-up of 4.3 years, 1,054 patients experienced a first major CVD event. The event rate increased stepwise with both higher CAC scores and number of vessels with obstructive disease (by CAC scores: 6.2 per 1,000 person-years (PY) for CAC = 0 to 42.3 per 1,000 PY for CAC >1,000; by number of vessels with obstructive disease: 6.1 per 1,000 PY for no CAD to 34.7 per 1,000 PY for 3-vessel disease). When stratified by 5 groups of CAC scores (0, 1 to 99, 100 to 399, 400 to 1,000, and >1,000), the presence of obstructive CAD was not associated with higher risk than presence of nonobstructive CAD. Plaque burden, not stenosis per se, is the main predictor of risk for CVD events and death. Thus, patients with a comparable calcified atherosclerosis burden generally carry a similar risk for CVD events regardless of whether they have nonobstructive or obstructive CAD.
Bibliographie:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
content type line 23
ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2020.10.021