TY - JOUR
T1 - Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease
T2 - From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)
AU - Lee, Ji Hyun
AU - Han, Donghee
AU - Hartaigh, Bríain
AU - Gransar, Heidi
AU - Lu, Yao
AU - Rizvi, Asim
AU - Park, Mahn Won
AU - Roudsari, Hadi Mirhedayati
AU - Stuijfzand, Wijnand J.
AU - Berman, Daniel S.
AU - Callister, Tracy Q.
AU - DeLago, Augustin
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Al-Mallah, Mouaz H.
AU - Budoff, Matthew J.
AU - Kaufmann, Philipp A.
AU - Raff, Gilbert
AU - Chinnaiyan, Kavitha
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Villines, Todd C.
AU - Kim, Yong Jin
AU - Leipsic, Jonathon
AU - Feuchtner, Gudrun
AU - Pontone, Gianluca
AU - Andreini, Daniele
AU - Marques, Hugo
AU - Rubinshtein, Ronen
AU - Achenbach, Stephan
AU - Shaw, Leslee J.
AU - Chang, Hyuk Jae
AU - Bax, Jeroen
AU - Chow, Benjamin
AU - Cury, Ricardo C.
AU - Gomez, Millie
AU - Jones, Erica C.
AU - Lin, Fay Y.
AU - Min, James K.
AU - Peña, Jessica M.
N1 - Funding Information:
Foundation for the National Institutes of Health, Grant/Award Number: R01 HL115150; Dalio Institute of Cardiovascular Imaging; Michael Wolk Foundation; The research reported in this study was funded by the National Institute of Health (Bethesda, Maryland) under grant number R01 HL115150. The research was also funded, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York)
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/5
Y1 - 2018/5
N2 - Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%–49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6–5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06–2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34–1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.
AB - Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%–49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6–5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06–2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34–1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.
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U2 - 10.1002/clc.22940
DO - 10.1002/clc.22940
M3 - Article
C2 - 29521447
AN - SCOPUS:85047784851
SN - 0160-9289
VL - 41
SP - 586
EP - 593
JO - Clinical Cardiology
JF - Clinical Cardiology
IS - 5
ER -