Autor(es):
Andreini, D ; Pontone, G ; Mushtaq, S ; Gransar, H ; Conte, E ; Bartorelli, AL ; Pepi, M ; Opolski, M ; Ó Hartaigh, B ; Berman, D ; Budoff, M ; Achenbach, S ; Al-Mallah, M ; Cademartiri, Fi ; Callister, T ; Chang, HJ ; Chinnaiyan, K ; Chow, B ; Cury, R ; Delago, A ; Hadamitzky, M ; Hausleiter, J ; Feuchtner, G ; Kim, YJ ; Kaufmann, PA ; Leipsic, J ; Lin, FY ; Maffei, E ; Raff, G ; Shaw, LJ ; Villines, TC ; Dunning, A ; Marques, H ; Rubinshtein, R ; Hindoyan, N ; Gomez, M ; Min, JK
Data: 2017
Identificador Persistente: http://hdl.handle.net/10400.17/2820
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): Aged; Cause of Death; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Female; Follow-Up Studies; Global Health; Humans; Male; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Registries; HCC CIR
Descrição
BACKGROUND: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality. RESULTS: Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not. CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.
