scholarly journals Adverse Cardiac Events Risks of Non-Obstructive Coronary Artery Disease by Cardiac CT Angiography at One-Year Follow-Up: Results of the Coronary Risk Determination in Intermediate Stratum Coronary CT Angiography (CORDISC) Study

2021 ◽  
Vol 7 (01) ◽  
pp. 1-8
Author(s):  
Somto Nwaedozie ◽  
Chuyang Zhong ◽  
Peter Umukoro ◽  
Paul Yeung-Lai-Wah ◽  
Rachel Gabor ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Cardiac Ct ◽  
Obstructive Coronary Artery Disease ◽  
Cardiac Events ◽  
Normal Coronary Arteries ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
Artery Disease ◽  
One Year

We conducted a retrospective cohort study of the adverse events at one year post-cardiac computed tomography (cardiac CT) using data gathered from the Marshfield Clinic Health System (MCHS) Cardiac CT registry to compare non-fatal myocardial infarction (MI), revascularization, all-cause mortality, and composite major adverse cardiac events (MACE) one year following cardiac CT in patients with non-obstructive coronary artery disease (CAD) and normal coronary arteries. From 2009 to 2017, the records of 2,649 patients who underwent cardiac CT were reviewed. CAD detected by cardiac CT was defined as normal (0% luminal stenosis) and non-obstructive (1-49% luminal stenosis). Clinical outcomes were nonfatal MI, revascularization, including percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG), all-cause mortality, and MACE. Cohorts were compared using t-tests and Fisher exact tests, and a logistic regression was performed to assess risk of clinical outcomes at one year. Compared with patients with normal coronary arteries, patients with non-obstructive coronary disease on cardiac CT had higher event rates of MACE (3.7% vs. 1.2%; P =0.006), revascularization (1.1% vs. 0.2%; P=0.033), and all-cause mortality (1.7% vs. 0.4%; P=0.012). After adjusting for baseline difference in demographics, risk factors, and medication use, the odds ratio of revascularization was 3.77 (95% CI: 1.03,13.79) and MACEs was 2.06 (95% CI: 0.94,4.51). Symptomatic congenital heart diseases accounted for about 50% of the non-death MACEs. Cardiac CT-defined non-obstructive CAD was associated with higher rates of revascularization, all-cause mortality and MACE compared to those with normal coronary arteries.

Prognostic Impact of Red Cell Distribution Width on the Development of Contrast Induced Nephropathy, Major Adverse Cardiac Events, and Mortality in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention.

2021 ◽  
Vol 17 ◽  
Author(s):  
Azka Latif ◽  
Muhammad Junaid Ahsan ◽  
Noman Lateef ◽  
Vikas Kapoor ◽  
Hafiz Muhammad Fazeel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Distribution Width ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease

: Red cell distribution width (RDW) serves as an independent predictor towards the prognosis of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention (PCI). A systematic search of databases such as PubMed, Embase, Web of Science, and Cochrane library was performed on October 10th, 2019 to elaborate the relationship between RDW and in hospital and long term follow up all-cause and cardiovascular mortality, major adverse cardiac events (MACE) and development of contrast-induced nephropathy (CIN) in patients with CAD undergoing PCI. Twenty-one studies qualified this strict selection criteria (number of patients = 56,425): one study was prospective, and the rest were retrospective cohorts. Our analysis showed that patients undergoing PCI with high RDW had a significantly higher risk of in-hospital all-cause mortality (OR 2.41), long-term all-cause mortality (OR 2.44), cardiac mortality (OR 2.65), MACE (OR: 2.16) and odds of developing CIN (OR: 1.42) when compared to the patients with low RDW. Therefore, incorporating RDW in the predictive models for the development of CIN, MACE, and mortality can help in triage to improve the outcomes in coronary artery disease patients who undergo PCI.

scholarly journals Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Non-Obstructive Coronary Artery Disease

2020 ◽  
Author(s):  
Zinuan Liu ◽  
Yipu Ding ◽  
Guanhua Dou ◽  
Xia Yang ◽  
Xi Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Sensitivity Analysis ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Obstructive Coronary Artery Disease ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Artery Disease

Abstract Background: The prognostic value of non-obstructive CAD has always been underestimated due to its moderate stenosis. Whether the atherosclerotic extent is related to the prognosis in this group of people is uncertain, especially in the presence of diabetes. We aim to investigate the prognostic value of atherosclerotic extent in diabetic patients with non-obstructive coronary artery disease (CAD).Method: The analysis was based on a single center cohort of diabetic patients referred for coronary computed tomography angiography (CCTA) due to suspect CAD. Major adverse cardiac events (MACEs) were recorded, including cardiovascular death, non-fatal myocardial infarction, stroke and unstable angina (UA) requiring hospitalization. Four groups were defined based on coronary stenosis combined with segment involvement score (SIS), a semiquantitative index of the extent of atherosclerosis, including normal, non-obstructive SIS<3, non-obstructive SIS≥3 and obstructive. Time to event was estimated by using multivariable Cox proportional hazards models. Leidon risk score was used to replace SIS for sensitivity analysis.Results: In total, 1241 patients were included (age 60.2±10.4 years, 54.1% male), experiencing 131 MACEs (10.6%) during a median follow-up of 2.6 years. Diabetic patients with non-obstructive CAD accounts for 50.2% of included population（N=623）. In multi-variate Cox model adjusting for age, gender, hyperlipidemia and presence of high-risk plaque, hazard ratio (HR) for SIS < 3 and SIS ≥ 3 in non-obstructive CAD were 1.84 (95%CI: 0.70-4.79) and 3.71 (95%CI: 1.37-10.00) respectively.The latter showed a higher risk of cardiac adverse events than the former group（HR：2.02 95%CI:1.11-3.68, p＝0.021）, while HR for obstructive CAD was 5.46 (95%CI: 2.18-13.69). Sensitivity analysis was performed using Leidon Risk Score instead of SIS. After adjustment, HR for Leidon ≥ 5 with non-obstructive disease was 1.92（95% CI: 1.06-3.48 p=0.032）in comparison to the non-obstructive group of Leidon < 5.Conclusion: In diabetic patients with non-obstructive CAD, atherosclerotic extent was associated with higher risk of major adverse cardiac events at long-term follow-up. Efforts should be made to determine risk stratification for the management of DM patients with non-obstructive CAD.

Abstract 24: Non-Obstructive Coronary Artery Disease Is Not Benign: Insights from the VA CART Program on the Association between Non-Obstructive Disease and Cardiac Events

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Thomas M Maddox ◽  
Maggie Stanislawski ◽  
Gary Grunwald ◽  
Steven Bradley ◽  
P. Michael Ho ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Obstructive Coronary Artery Disease ◽  
Cox Proportional Hazards ◽  
Cardiac Care ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
Secondary Analyses ◽  
Artery Disease

Introduction: The traditional focus of cardiac care on obstructive (>70% stenosis) CAD potentially distracts from the risks inherent in non-obstructive CAD. However, surprisingly little is known about non-obstructive CAD outcomes. Therefore, we determined the association between non-obstructive CAD and cardiovascular outcomes. Methods: Using the national VA CART program, we studied all veterans undergoing elective coronary angiography for angina between October 2007 and September 2012. Patients were categorized by CAD extent (none (no stenosis >20%), non-obstructive (no stenosis >=70%), obstructive (any stenosis >=70%)) and distribution (1, 2, or 3 vessel), and assessed for major adverse cardiac events (MACE), defined as all-cause mortality and MI. We adjusted for demographic, clinical, and treatment factors using Cox proportional hazards modeling. Secondary analyses sub-divided non-obstructive CAD into mild (20-49% stenosis) and moderate (50-69% stenosis) disease. Results: During the study period, 40,872 veterans underwent catheterization. Of these, 8411 (20.6%) had no CAD, 5219 (17.7%) had 1V non-obstructive CAD, 3034 (10.3%) had 2V non-obstructive CAD, 1388 (4.7%) had 3V non-obstructive CAD, 8588 (29.1%) had 1V obstructive, 5227 (17.7%) had 2V obstructive, and 6017 (20.4%) had 3V/LM obstructive CAD. MACE rates progressively increased with increasing CAD severity (Figure). This association persisted after risk adjustment (HR 1.28 (1.08, 1.51) for 1V non-obstructive, 1.29 (1.08, 1.52) 2V non-obstructive, 1.44 (1.12, 1.86) 3V non-obstructive, 1.93 (1.64, 2.28) 1V obstructive, 2.73 (2.28, 3.27) 2V obstructive, and 2.98 (2.52, 3.53) 3V/LM obstructive CAD)). A trend toward higher MACE in moderate 3V non-obstructive compared to 1V obstructive CAD (HR 1.34 (0.71, 2.52)) was noted. Conclusions: Non-obstructive CAD, relative to no CAD, is associated with 28-44% higher odds of MACE. MACE risk progressively increases by CAD extent, rather than abruptly increasing between non-obstructive and obstructive CAD. The risks of adverse events were similar for 3V non-obstructive CAD and 1V obstructive CAD, highlighting the limitations of a dichotomous characterization of angiographic CAD and a need to recognize the risks inherent in non-obstructive CAD.

scholarly journals Myocardial infarction with non-obstructive coronary arteries as compared with myocardial infarction and obstructive coronary disease: outcomes in a Medicare population

2019 ◽  
Vol 41 (7) ◽  
pp. 870-878 ◽  
Author(s):  
Rachel P Dreyer ◽  
Rosanna Tavella ◽  
Jeptha P Curtis ◽  
Yongfei Wang ◽  
Sivabaskari Pauspathy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Cardiac Events ◽  
Data Registry ◽  
Adverse Cardiac Events ◽  
Secondary Endpoints ◽  
Observational Cohort ◽  
Artery Disease

Abstract Aims The prognosis of patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) is poorly understood. We examined major adverse cardiac events (MACE) defined as all-cause mortality, re-hospitalization for acute myocardial infarction (AMI), heart failure (HF), or stroke 12-months post-AMI in patients with MINOCA versus AMI patients with obstructive coronary artery disease (MICAD). Methods and results Multicentre, observational cohort study of patients with AMI (≥65 years) from the National Cardiovascular Data Registry CathPCI Registry (July 2009–December 2013) who underwent coronary angiography with linkage to the Centers for Medicare and Medicaid (CMS) claims data. Patients were classified as MICAD or MINOCA by the presence or absence of an epicardial vessel with ≥50% stenosis. The primary endpoint was MACE at 12 months, and secondary endpoints included the components of MACE over 12 months. Among 286 780 AMI admissions (276 522 unique patients), 16 849 (5.9%) had MINOCA. The 12-month rates of MACE (18.7% vs. 27.6%), mortality (12.3% vs. 16.7%), and re-hospitalization for AMI (1.3% vs. 6.1%) and HF (5.9% vs. 9.3%) were significantly lower for MINOCA vs. MICAD patients (P &lt; 0.001), but was similar between MINOCA and MICAD patients for re-hospitalization for stroke (1.6% vs. 1.4%, P = 0.128). Following risk-adjustment, MINOCA patients had a 43% lower risk of MACE over 12 months (hazard ratio = 0.57, 95% confidence interval 0.55–0.59), in comparison to MICAD patients. This pattern was similar for adjusted risks of the MACE components. Conclusion This study confirms an unfavourable prognosis in elderly patients with MINOCA undergoing coronary angiography, with one in five patients with MINOCA suffering a major adverse event over 12 months.

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