Clinical significance of aortic arch plaques simultaneously assessed with coronary atherosclerosis on cardiovascular outcomes in patients undergoing coronary CT angiography

Abstract Aims Computed tomography (CT) coronary angiography is a useful diagnostic imaging modality in assessing presence, severity, and extent of coronary artery disease (CAD). Aortic arch plaques have been shown to be an underlying cause of embolic stroke and also related to increased risk of cardiovascular events. Yet, conventional CTCA imaging protocol does not include aortic arch for the reduction of radiation exposure. This study aimed to investigate prevalence of aortic arch plaques simultaneously assessed by CTCA and their clinical significance in combination with the presence of obstructive CAD for prediction of CVD events in patients with suspected CAD. Methods This study consisted of 310 (mean age, 66 years old, 42% female) patients with suspected CAD undergoing CTCA between 2017 and 2019. All CTCA examination was performed with 320-row detector scanner using ECG-triggered prospective gating method. Aortic arch images were simultaneously acquired during CTCA scanning without an increase of contrast media. Using Agatston method, coronary artery calcium score (CACS) was categorized into either of the groups having CACS of 0, 0–99, 100–299, or more than 300. The presence of CAD was reported as non-obstructive or obstructive CAD. High-risk featured aortic plaque was defined as large plaques >4 mm in thickness showing ulceration or protrusion. A composite event of cardiovascular disease, including all-cause mortality, non-fatal myocardial infarction, unplanned hospitalization requiring revascularization or stroke was defined as the primary endpoint. Results Patients having CACS of 0, 0–99, 100–299, and >300 were found in 41%, 24%, 15%, 20%%, respectively, where obstructive CAD was diagnosed in 11%. Aortic HRPs in ascending aorta, aortic arch, and thoracic descending aorta were observed in 1.6%, 6.9%, and 15%, respectively. During a mean follow-up period of 2.2 years, the primary endpoint was observed in 27 patients (8.7%). Cox regression hazard model demonstrated an independent association of aortic arch high-risk plaques (HR; 3.2, 95% CI; 1.20–8.64, p=0.02) and obstructive CAD (HR; 3.3, 95% CI; 1.45–7.92, P=0.005) when adjusted by age, CACS, and chronic kidney disease. Kaplan-Meier curve analysis showed a worse outcome of patients with aortic HRP and obstructive CAD compared to those without aortic plaques and obstructive CAD (p<0.001). Conclusion This study demonstrated an independent association of aortic arch high-risk featured plaques with CVD events. Further study is warranted whether pharmacological interventional therapies can reduce future CVD risks in patients with CAD and aortic arch plaques. FUNDunding Acknowledgement Type of funding sources: None.

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Aortic arch calcification is strongly associated with coronary artery calcification

VASA ◽

10.1024/0301-1526/a000415 ◽

2015 ◽

Vol 44 (2) ◽

pp. 106-114 ◽

Cited By ~ 7

Author(s):

Adem Adar ◽

Hakan Erkan ◽

Tayyar Gokdeniz ◽

Aysegul Karadeniz ◽

Ismail G. Cavusoglu ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Aortic Arch ◽

Chest Radiography ◽

Coronary Artery Calcification ◽

Independent Predictor ◽

Study Group ◽

Discriminative Performance ◽

Sensitivity Specificity ◽

Aortic Arch Calcification

Background: We aimed to investigate the association between aortic arch and coronary artery calcification (CAC). We postulated that low‐ and high‐risk CAC scores could be predicted with the evaluation of standard chest radiography for aortic arch calcification (AAC). Patients and methods: Consecutive patients who were referred for a multidetector computerized tomography (MDCT) examination were enrolled prospectively. All patients were scanned using a commercially available 64‐slice MDCT scanner for the evaluation of CAC score. A four‐point grading scale (0, 1, 2 and 3) was used to evaluate AAC on the standard posterior‐anterior chest radiography images. Results: The study group consisted of 248 patients. Median age of the study group was 52 (IQR: 10) years, and 165 (67 %) were male. AAC grades (r = 0.676, p < 0.0001) and age (r = 0.518, p < 0.0001) were significantly and positively correlated with CAC score. Presence of AAC was independently associated with the presence of CAC (OR: 11.20, 95 % CI 4.25 to 29.52). An AAC grade of ≥ 2 was the strongest independent predictor of a high‐risk CAC score (OR: 27.42, 95 % CI 6.09 to 123.52). Receiver operating characteristics curve analysis yielded a strong predictive ability of AAC grades for a CAC score of ≥ 100 (AUC = 0.892, P < 0.0001), and ≥ 400 (AUC = 0.894, P < 0.0001). Absence of AAC had a sensitivity, specificity and accuracy of 90 %, 84 % and 89 %, respectively, for a CAC score of < 100. An AAC grade of ≥ 2 predicted a CAC score of ≥400 with a sensitivity, specificity and accuracy of 68 %, 98 % and 95 %, respectively. Conclusions: AAC is a strong and independent predictor of CAC. The discriminative performance of AAC is high in detecting patients with low‐ and high‐risk CAC scores.

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Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

Scientific Reports ◽

10.1038/s41598-021-97917-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Francisco Albuquerque ◽

Pedro de Araújo Gonçalves ◽

Hugo Marques ◽

António Ferreira ◽

Pedro Freitas ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Right Coronary Artery ◽

Cardiac Death ◽

Anomalous Origin ◽

Cardiac Symptoms ◽

Asymptomatic Patients ◽

Increased Risk ◽

The Right

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

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Abstract 78: Risk Factors Associated with Failure of Aggressive Medical Therapy in the SAMMPRIS Trial

Stroke ◽

10.1161/str.45.suppl_1.78 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Michael F Waters ◽

Brian L Hoh ◽

Michael J Lynn ◽

Tanya N Turan ◽

Colin P Derdeyn ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Medical Therapy ◽

Primary Endpoint ◽

Univariate Analysis ◽

Baseline Risk ◽

Medical Group ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

Background: The SAMMPRIS trial showed that aggressive medical therapy was more effective than stenting for preventing stroke in high-risk patients with symptomatic intracranial stenosis. However, 15% of patients in the medical group still had a primary endpoint (any stroke or death within 30 days of enrollment or stroke in the territory beyond 30 days) during a median follow-up of 32.7 months. We sought to determine baseline risk factors that were associated with a primary endpoint in the medical arm of SAMMPRIS. Methods: Data on 227 patients randomized to the medical group in SAMMPRIS were analyzed. Baseline demographic features, vascular risk factors, qualifying event, brain imaging and angiographic features were analyzed. The hazard ratio and p-value from a Cox proportional hazard regression model relating time until a primary endpoint to each factor were calculated. Results: Female gender, diabetes, stroke as the qualifying event (especially non-penetrator stroke), old infarct in the territory of the stenotic artery, and > 80% stenosis were associated (p < 0.10) with a higher risk of the primary endpoint on univariate analysis (see accompanying table) (multivariate analysis will be available by the time of ISC). Variables not associated with a higher risk of a primary endpoint in the medical arm included: age, race, antithrombotic therapy at the time of a qualifying event, time from qualifying event to enrollment (< 7 days vs. > 7 days), and location of stenosis. Conclusions: Several features were associated with an increased risk of the primary endpoint in the medical group in SAMMPRIS. On univariate analysis, the most important risk factors were an old infarct in the territory of the stenotic artery and stroke (especially non-penetrator stroke) as the qualifying event. These features will be useful for identifying particularly high-risk patients who should be targeted for future clinical trials testing alternative therapies to aggressive medical management.

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Risk results from screening for a high cardiovascular disease risk by means of traditional risk factor measurement or coronary artery calcium scoring in the ROBINSCA trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2959 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Van Der Aalst ◽

S.J.A.M Denissen ◽

M Vonder ◽

J.-W.C Gratema ◽

H.J Adriaansen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery ◽

High Risk ◽

Risk Score ◽

Coronary Artery Calcium ◽

Preventive Treatment ◽

Low Risk ◽

Funding Source ◽

Cvd Risk ◽

Increased Risk

Abstract Aims Screening for a high cardiovascular disease (CVD) risk followed by preventive treatment can potentially reduce coronary heart disease (CHD)-related morbidity and mortality. ROBINSCA (Risk Or Benefit IN Screening for CArdiovascular disease) is a population-based randomized controlled screening trial that investigates the effectiveness of CVD screening in asymptomatic participants using the Systematic COronary Risk Evaluation (SCORE) model or Coronary Artery Calcium (CAC) scoring. This study describes the distributions in risk and treatment in the ROBINSCA trial. Methods and results Individuals at expected elevated CVD risk were randomized (1:1:1) into the control arm (n=14,519; usual care); screening arm A (n=14,478; SCORE, 10-year fatal and non-fatal risk); or screening arm B (n=14,450; CAC scoring). Preventive treatment was largely advised according to current Dutch guidelines. Risk and treatment differences between the screening arms were analysed. 12,185 participants (84.2%) in arm A and 12,950 (89.6%) in arm B were screened. 48.7% were women, and median age was 62 (InterQuartile Range 10) years. SCORE screening identified 45.1% at low risk (SCORE<10%), 26.5% at intermediate risk (SCORE 10–20%), and 28.4% at high risk (SCORE≥20%). According to CAC screening, 76.0% were at low risk (Agatston<100), 15.1% at high risk (Agatston 100–399), and 8.9% at very high risk (Agatston≥400). CAC scoring significantly reduced the number of individuals indicated for preventive treatment compared to SCORE (relative reduction women: 37.2%; men: 28.8%). Conclusion We showed that compared to risk stratification based on SCORE, CAC scoring classified significantly fewer men and women at increased risk, and less preventive treatment was indicated. ROBINSCA flowchart Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): Advanced Research Grant

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Low-Density Lipoprotein Subfractionation: What Is the Role of the Lab When Reporting Discrepant Results?

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa137.015 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S8-S9

Author(s):

Nicholas E Larkey ◽

Leslie J Donato ◽

Allan S Jaffe ◽

Jeffrey W Meeusen

Keyword(s):

Coronary Artery ◽

High Risk ◽

Clinical Decision Making ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Risk ◽

Lipid Lowering ◽

Low Density ◽

Small Dense Ldl ◽

Increased Risk

Abstract Plasma concentrations of low-density-lipoprotein cholesterol (LDL-C) are directly associated with risk for coronary artery disease (CAD). Multisociety guidelines define LDL-C>160mg/dL as a risk factor for CAD and LDL-C>190mg/dL as an indication for lipid lowering medication, regardless of other clinical factors. Subfractionation of LDL according to size (LDL-s) enables differentiation between two LDL phenotypes: large-buoyant LDL and small-dense LDL. The small-dense LDL phenotype reportedly conveys increased risk for CAD. Major societies do not recommend LDL subfractions be used for clinical decision making and most payers do not cover LDL subfraction testing. Despite these restrictions, LDL subfraction is routinely requested by clinicians. Nuclear magnetic resonance (NMR) spectroscopy measures LDL-C and LDL-s. Following inquiries regarding interpretation of conflicting LDL-C and LDL-s results, we investigated associations between LDL-C and LDL-s measured by NMR in order to determine how often they provide contradicting or additive information. Verification of NMR LDL-C accuracy was confirmed by ÃŸ-quantification in a subset of patient samples (n=250). The average bias was -4.5mg/dL and the correlation coefficient was 0.92. High-risk was defined as LDL-C>160mg/dL or LDL-s<20.5 nm (small-dense LDL); and low-risk was defined as LDL-C<70mg/dL or LDL-s>20.5nm (large-buoyant LDL). In 26,710 clinical NMR analyses, the median LDL-C was 94.0mg/dL (range:5-436mg/dL) with median LDL-s of 20.8 nm (range:19.4–23.0nm). LDL-s moderately correlated with LDL-C (Ï#129;=0.51;p<0.01). Small-dense-LDL was identified in only 18% (407/2,191) of patients with elevated LDL-C (>160mg/dL) and was more common (73.2% of 6,093) in patients with low LDL-C (<70mg/dL;p<0.001). Associations with CAD were investigated among patients without cholesterol-lowering medication treatment referred for angiography (n=356). CAD (defined as stenosis >50% in one or more coronary artery) was diagnosed in 14% (1/7) of subjects with low LDL-C (<70mg/dL) compared to 59% (47/80) of subjects with elevated LDL-C (p=0.01). When stratifying by LDL-s, CAD was diagnosed in 50% (57/115) of subjects with small-dense LDL compared to 43% (104/241) of subjects with large-buoyant LDL (p=0.2). Small-dense LDL was identified in only 33% (26/80) of cases with elevated LDL-C. Limiting to subjects with elevated LDL-C, CAD was diagnosed in 50% (13/26) of subjects with concordant (high-risk) small-dense LDL compared to 61% (33/54) of subjects with discordant (low-risk) large-buoyant LDL (LDL-s>20.5nm) (p=0.3). Our data confirm that LDL-s subfraction measured by NMR is reported discordantly in most cases when LDL-C is unequivocally high or low. Furthermore, CAD diagnosis was significantly associated with LDL-C, but not with LDL-s. Our data also show that in discrepant samples, elevated LDL-C correlates better with disease state compared to LDL-s. Therefore, LDL-s should not be used to justify treatment decisions in patients with elevated LDL-C. Laboratories should consider carefully whether or not to report LDL-s when it is known that misleading and discordant values will be reported in a majority of cases.

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First-ever ischemic stroke and increased risk of incident heart disease in older adults

Neurology ◽

10.1212/wnl.0000000000009234 ◽

2020 ◽

Vol 94 (15) ◽

pp. e1559-e1570 ◽

Cited By ~ 4

Author(s):

Luciano A. Sposato ◽

Melody Lam ◽

Britney Allen ◽

Lucie Richard ◽

Salimah Z. Shariff ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Cox Regression ◽

Large Population ◽

Population Based ◽

Cardiac Complications ◽

Comorbid Conditions ◽

Increased Risk ◽

Shared Risk

ObjectivePoststroke cardiac complications are common. It is unknown whether the reason is shared risk factors and preexisting heart disease or stroke-associated myocardial and coronary injury. We tested the hypothesis that first-ever ischemic stroke is associated with increased risk of incident cardiovascular complications in patients without known preexisting cardiac comorbid conditions.MethodsThis population-based cohort study included residents in Ontario between 2002 and 2012 who were ≥66 years of age without known cardiovascular disease. We compared the incident risk of major adverse cardiovascular events (MACE), defined as myocardial infarction, unstable angina, congestive heart failure, coronary artery disease, coronary artery revascularization, or cardiovascular death, at 1 year in patients with first-ever ischemic stroke vs propensity-matched individuals without stroke (4:1 matching using 31 variables). To estimate cause-specific hazard ratios (HRs), we used Cox regression models adjusted for variables with weighted standardized differences >0.10 or known to influence the risk of MACE.ResultsWe included 21,931 patients with first-ever ischemic stroke and 71,696 propensity-matched individuals, well balanced on all variables used for propensity matching. First-ever ischemic stroke was associated with increased unadjusted incident MACE risk (HR 4.5, 95% confidence interval [CI] 4.3–4.8). MACE adjusted risk was highest in the first 30 days (HR 25.0, 95% CI 20.5–30.5) and declined both at 31 to 90 days (HR 4.8, 95% CI 4.1–5.7) and at 91 to 365 days (HR 2.2, 95% CI 2.0–2.4).ConclusionsIn this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE. Whether this association is explained by stroke-associated cardiac injury, preexisting subclinical cardiovascular comorbid conditions, or both remains unknown.

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High-risk lifestyle and all-cause mortality in older Australians with stroke: A data linkage study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1119 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

W Peng ◽

Andrew Hayen ◽

J a n e Maguire ◽

J o n Adams ◽

David Sibbritt

Keyword(s):

Public Health ◽

High Risk ◽

Cox Regression ◽

Healthy Lifestyle ◽

Lifestyle Factors ◽

Stroke Survivors ◽

Vigorous Exercise ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Stroke prevention via lifestyle modification is a public health priority in developed countries. Few studies have examined the association of high-risk lifestyle factors with long-term mortality of stroke survivors. Therefore, this study aims to explore the effect of key lifestyle factors on all-cause mortality after stroke. Methods Sample is derived from the 45 and Up Study, the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. The lifestyle data in the 45 and Up Study between 2006 to 2015 were linked with data from the NSW Registry of Births, Deaths and Marriages, NSW Cause of Death Unit Record File, and NSW Admitted Patient Data Collection by the Centre for Health Record Linkage. We defined a high-risk lifestyle as no vigorous exercise, smokers, or > 10 alcoholic drinks/week. Multivariate Cox regression model is used to examine the effect of high-risk lifestyle on survival using 10-year all-cause mortality as the main outcome, adjusted for key confounders. Results We analysed information on 8410 adults with a stroke event occurring prior to the baseline 45 and Up Study, and 31% of them died in 10 years. 6219 participants were identified as having a high-risk lifestyle at baseline. Being a current smoker and without vigorous exercise were associated with 41% (95% CI: 16%, 73%) and 52% (95% CI: 30%, 78%) increase in the likelihood of death in 10 years, respectively. However, high-risk alcohol drinking was not significantly associated with survival. Of note, having cardiovascular-related comorbidities showed greater risks of mortality (HR range, 3.6-7.2). Conclusions High-risk lifestyle factors were associated with an increased risk of long-term all-cause mortality, suggesting that enhancing public health initiatives to promote 'healthy' lifestyle behaviours can be of great benefit to stroke survivors. Key messages It is essential for stroke survivors to maintain a healthy lifestyle to delay all-cause mortality. Stroke survivors with high-risk lifestyle may be associated with increased likelihood of death if they have comorbidities such as diabetes and hypertension.

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External validation of the Glasgow prognostic score (mGPS) for renal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.378 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 378-378

Author(s):

Viraj A. Master ◽

Timothy V. Johnson ◽

Omer Kucuk ◽

Daniel Canter ◽

John Pattaras ◽

...

Keyword(s):

High Risk ◽

Cox Regression ◽

Inflammatory Responses ◽

Prognostic Score ◽

External Validation ◽

Glasgow Prognostic Score ◽

Low Risk ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

378 Background: Inflammation has been termed the 7th hallmark of cancer (Hanahan and Weinberg Cell 2011). Measurement of systemic inflammatory responses in malignancy is possible using a selective combination of two commonly available, cost-effective serum assays. The combination of these two serum markers, C-reactive protein (CRP) and albumin, is termed the modified Glasgow prognostic score (mGPS), and is strongly correlated with outcome in a variety of cancers, including mRCC. Recently, mGPS has been shown to be predictive of outcome in localized RCC (ASCO GU 2010 #390). We sought to externally validate these results. Methods: Nephrectomized patients with clinically localized (T1-T4N0M0) clear cell RCC with negative surgical margins were followed for a mean of 25 months (range: 1-81 months). Relapse and survival was identified through routine follow-up. Patients were categorized by mGPS score as Low Risk (mGPS = 0 points), Intermediate Risk (mGPS = 1 point), and High Risk (mGPS = 2 points). One point was assigned to patients for an elevated CRP (>10 mg/L) and hypoalbuminemia (<3.5 mg/dL). Patients with normal CRP and hypoalbuminemia were assigned 0 points. Kaplan-Meier and multivariate Cox regression analyses examined relapse-free survival (RFS) and overall survival (OS) across patient and disease characteristics. Results: Of 248 patients, 17.9% relapsed and 18.6% died. Of Low, Intermediate, and High Risk patients, 7.2%, 7.7%, and 45.5%, respectively relapsed and 5.2%, 15.4%, and 39.4%, respectively died during the study. In multivariate analysis including stage and grade, mGPS was significantly associated with RFS and OS. Compared to Low-Risk patients, High-Risk patients experienced a 3-fold (OR: 2.906, 95% CI: 1.055-8.001) increased risk of relapse and 4-fold (HR: 3.722, 95% CI: 1.046-13.245) increased risk of mortality. AUC is 0.813, which compares very favorably to existing prognostic algorithms. Conclusions: In this external validation cohort of US patients, mGPS continues to be a predictor of relapse and overall mortality following nephrectomy for localized RCC. Clinicians may consider using mGPS as an adjunct to identify high-risk patients for possible enrollment into clinical trials, or for patient counseling.

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Abstract P447: Cellular Adhesion Molecules: Early Indicators of Subsequent Clinical Cardiovascular Disease Events in a Young Adult Population. The CARDIA Study.

Circulation ◽

10.1161/circ.129.suppl_1.p447 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Myron D Gross ◽

Andrew O Odegaard ◽

Suzette J Bielinski ◽

Jose R Suarez-Lopez ◽

J. Jeffrey Carr ◽

...

Keyword(s):

Cardiovascular Disease ◽

Young Adults ◽

Coronary Artery ◽

Adhesion Molecules ◽

Cox Regression ◽

Early Stage ◽

Adult Population ◽

Cellular Adhesion ◽

Cellular Adhesion Molecules ◽

Increased Risk

Background: Cellular adhesion molecules (CAM) have a central role in the accumulation of circulating leukocytes at sites of vascular injury, infection and/ inflammation, and have been associated with the development of atherosclerotic plaque and coronary artery disease in mature adults. Objective: To test the hypothesis that higher overall circulating CAM levels in young adults predict cardiovascular disease (CVD) events over the next 18 years. Method: We measured several circulating CAM molecules (ICAM-1, P-selectin, E-selectin and VCAM) in the Coronary Artery Risk Development in Young Adults (CARDIA) study at exam year 7 (1992-93, black and white men and women, CVD-free, mean age 32, range 25-37 years, n=2428) and monitored incident CVD events (n=70, including coronary heart disease, stroke, and heart failure, adjudicated based on medical records) through exam year 25, mean age of 50 years. We ranked each CAM in quintiles (coded 0-4) and summed the ranks across CAMs into an index to examine the association with incident CVD with Cox regression models. Results: Unadjusted cumulative CVD event rates were 1.6% (sum of CAM quartile ranks 0-8: 22 events in 1353 participants), 2.3% (sum of ranks 9-12: 29/813), and 7.3% (sum of ranks 13-16: 19/262). In proportional hazards regression analysis adjusted for year 7 age, sex, race, clinic, education, smoking, diet, physical activity, body mass index, blood pressure, blood lipids, and blood glucose, sum of ranks 13-16 were associated with a higher risk of CVD compared to the referent (rank sum 0-8) (See Table). Conclusion: High levels of circulating CAMs at an early stage of adulthood (mean age 32, range 25-37 years) were associated with an increased risk of incident CVD events. CAMs may be an early biomarker for development of subclinical CVD, even in CVD-free young adults with low atherosclerosis burden and decades prior to the development of clinical CVD.

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Abstract P85: Are Myocardial Bridges Associated With Increased Risk of Death or Myocardial Infarction?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap85 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Mouaz H Al-Mallah ◽

Kamal Kassem ◽

Owais Khawaja ◽

Thomas Song ◽

Chad Poopat ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Prognostic Value ◽

Cox Regression ◽

Study Cohort ◽

Risk Of Death ◽

Increased Risk ◽

Artery Disease

Background: Myocardial bridging (MB) is frequently seen on coronary CT angiography (CCTA). However, there has been conflicting data on the prognostic value of MB. The aim of this analysis is to determine the prognostic value of MB in patients without obstructive coronary artery disease (CAD) (<50 diameter stenosis). Methods: We included patients with no known prior coronary artery disease (CAD) who underwent CCTA for various clincial reasons. Patients with obstructive CAD on CCTA were excluded. The study cohort was followed for all cause mortality or myocardial infarction (MI) (median follow-up 1.7 years). Group comparisons were made between patients with patients with or without MB. Results: A total of 715 patients were included in this analysis of which 68 patients had MB (10%). 73% of the bridges were in the mid LAD and 22% had bridging in the distal LAD. 48% of the study cohort had normal coronaries, while 52% had evidence of non obstructive CAD. There were no differences in the baseline characteristics, symptomatic status or prevalence of non obstructive CAD between the two groups (all p>0.5). After a median follow-up duration of 1.7 years, 23 patients died and 10 patients experienced myocardial infarction. There were no statistically significant differences in the rate of death/MI between the two groups (figure). Using multivariable Cox regression, the presence of MB was not associated with increased risk for death/MI (Adjusted HR 0.4, 95% confidence interval 0.1 -2.8, p=0.34) Conclusions: In patients with non-obstructive CAD, MB is not associated with increased risk for all cause death or MI.

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