scholarly journals Importance of Visual Estimation of Coronary Artery Stenoses and Use of Functional Evaluation for Appropriate Guidance of Coronary Revascularization—Multiple Operator Evaluation

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2241
Author(s):  
Lucian Calmac ◽  
Nicoleta-Monica Popa-Fotea ◽  
Vlad Bataila ◽  
Vlad Ploscaru ◽  
Adrian Turea ◽  
...  
Keyword(s):  
Group Decision ◽  
Coronary Revascularization ◽  
Invasive Coronary Angiography ◽  
Functional Evaluation ◽  
Visual Estimation ◽  
Significant Difference ◽  
Coronary Artery Stenoses ◽  
Coronary Stenoses ◽  
Coronary Lesions ◽  
Multiple Operator

Background: Visual estimation (VE) of coronary stenoses is the first step during invasive coronary angiography. The aim of this study was to evaluate the accuracy of VE together with invasive functional assessment (IFA) in defining the functional significance (FS) of coronary stenoses based on the opinion of multiple operators. Methods: Fourteen independent operators visually evaluated 133 coronary lesions which had a previous FFR measurement, indicating the degree of stenosis (DS), FS and IFA intention. We determined the accuracy of FS prediction using several scenarios combining individual and group decision, considering IFA as deemed necessary by the operator or only in intermediate lesions. Results: The accuracy of VE in predicting FS was largely variable between operators (average 66.1%); it improved significantly when IFA was used either as per operator’s opinion (86.3%; p < 0.0001) or only in intermediate DS (82.9; p < 0.0001). There was no significant difference between using IFA per observer’s opinion or only in intermediate DS lesions (p = 0.166). The poorest accuracy of VE for FS was obtained in intermediate DS lesions (59.1%). Conclusions: There are significant inter-observer differences in reporting the degree of DS, while the accuracy of VE prediction of FS is also largely dependent on the operator, and the worst performance is obtained in the evaluation of intermediate DS.

Preprocedural β-Blockers in the Functional Assessment of Intermediate Coronary Lesions by Instantaneous Wave-Free Ratio

Angiology ◽  
2021 ◽  
pp. 000331972199617
Author(s):  
Monica Verdoia ◽  
Rocco Gioscia ◽  
Matteo Nardin ◽  
Orazio Viola ◽  
Marta Francesca Brancati ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Lesion Length ◽  
Functional Evaluation ◽  
Luminal Diameter ◽  
Coronary Syndrome ◽  
Coronary Stenoses ◽  
Minimal Luminal Diameter ◽  
Coronary Lesions ◽  
Β Blockers ◽  
The Impact

Aim: Instantaneous wave-free ratio (iFR) has emerged as the strategy of choice for the assessment of intermediate coronary lesions. The impact of preprocedural β-blockers therapy on the iFR was the aim of this study. Methods: We included patients undergoing functional assessment of intermediate (40%-70%) coronary lesions in 2 centers. The iFR measurement was performed by pressure-recording guidewire and calculated at the core laboratory using the manufacturers’ dedicated software. Minimal luminal diameter, reference diameter, percent diameter stenosis, and length of the lesion were measured. Positive iFR was considered for values <0.90. Results: We included 197 patients undergoing functional evaluation of 223 coronary lesions. Patients on β-blockers (69%) had more frequently hypertension ( P = .05); previous myocardial infarction ( P = .01); therapy with clopidogrel ( P = .02), statins, and aspirin; and acute coronary syndrome at presentation ( P < .001, respectively). Mean iFR values were slightly higher in patients on β-blockers (0.94 ± 0.06 vs 0.92 ± 0.06, P = .11). The rate of positive iFR was significantly lower with β-blockers (14.9% vs 27.5%, P = .04). On multivariate analysis, β-blockers use was a predictor of the significance of coronary stenoses (odds ratio [OR] = 0.48; 95% CI = 0.23-0.98; P = .05) together with lesion length (OR = 1.04; 95% CI = 1.01-1.07; P = .007). Conclusion: Among patients undergoing iFR, preprocedural β-blockers are associated with higher absolute values and a lower rate of positive iFR.

Diagnostic accuracy of Instantaneous Wave-Free Ratio (iFR) for the assessment of myocardial ischaemia: a comparison with non-invasive stress imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Stazzoni ◽  
L Tessandori ◽  
P Spontoni ◽  
M Angelillis ◽  
C Giannini ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Myocardial Ischaemia ◽  
Gold Standard ◽  
Coronary Revascularization ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Coronary Stenoses ◽  
Epicardial Stenosis

Abstract Background Instantaneous Wave-Free Ratio (iFR) allows for the assessment of the haemodynamic effects of epicardial coronary stenoses without the need for hyperaemia; iFR is currently recommended as a means to evaluate myocardial ischaemia. Purpose To assess the diagnostic accuracy of iFR with respect to the identification of coronary epicardial stenoses causing ischemia. Therefore, we combined anatomical (% stenosis at invasive coronary angiography, ICA) and functional (non-invasive imaging stress test, NIST) information to obtain a “gold standard” for the identification of stenoses causing ischaemia. Methods We enrolled 71 patients (52 male, 19 female; age mean 68.4±8.1 years) with chronic coronary syndrome or low-risk acute coronary syndrome without ST segment elevation who had at least a NIST and who had at least one vessel with a 50%-85% stenosis at ICA. iFR was measured in all coronary arteries with stenosis &gt;50% and categorised according to the 0.89 threshold for ischaemia. Results iFR was assessed in 122 vessels. In a per-vessel analysis, in 56.7% ischaemia was present both at iFR and NIST, in 21.3% ischaemia was absent in both, while in 23.0% ischaemia was found at NIST but not confirmed by iFR. The overall accuracy of iFR with respect to NIST was 90.1%. However, when considering as the “gold standard” for coronary disease causing ischaemia the contemporary presence of an epicardial stenosis &gt;70% at ICA and a positive NIST, the diagnostic accuracy of iFR greatly improved. The sensibility, specificity, PPV, NPV and accuracy were 96.5%, 75.0%, 73.3%, 96.7% and 84.4%, respectively. In case of discordance between NIST and iFR, revascularization was based on iFR. At a mean follow-up of 23±18 months, the composite endpoint of MACE (major adverse cardiac events, defined as the composite of all-cause death, nonfatal MI and unplanned coronary revascularization) occurred in 16.4%, while death/MI occurred in 11.9%. Stratification according to the per-patient concordance between iFR and NIST showed no significant differences in rates of MACE (p=0.50) and death/MI (p=0.20). Stratification based on iFR showed a higher death/MI rate in iFR-positive patients (11.9% vs. 0%, p=0.047) and a trend to higher MACE rate (11.9% vs. 4.47% p=0.14), Conclusions The diagnostic accuracy of iFR is low when compared with NIST as the reference for myocardial ischaemia, but it is very high when compared with the combined presence of epicardial stenosis and positive NIST. Therefore, iFR can accurately guide the decision to treat or defer revascularization of intermediate coronary stenoses, being most useful in patients with multivessel CAD and when non-invasive functional data are lacking or discordant with anatomy. Funding Acknowledgement Type of funding source: None

scholarly journals Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry

2020 ◽  
Vol 41 (42) ◽  
pp. 4127-4137 ◽  
Author(s):  
Ersilia M DeFilippis ◽  
Bradley L Collins ◽  
Avinainder Singh ◽  
David W Biery ◽  
Amber Fatima ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sex Differences ◽  
Cardiovascular Mortality ◽  
Angiotensin Receptor Blockers ◽  
Coronary Revascularization ◽  
Invasive Coronary Angiography ◽  
Young Age ◽  
Converting Enzyme Inhibitors ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Aims There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age. Methods and results Consecutive patients presenting to two large academic medical centres with a Type 1 MI at ≤50 years of age between 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P &lt; 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P &lt; 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P &lt; 0.001), and statins (82.4% vs. 88.4%, P &lt; 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61). Conclusions Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.

scholarly journals Complex Coronary Hemodynamics - Simple Analog Modelling as an Educational Tool

2017 ◽  
Vol 11 (1) ◽  
pp. 12-19
Author(s):  
Gaurav R. Parikh ◽  
Elvis Peter ◽  
Nikolaos Kakouros
Keyword(s):  
Invasive Coronary Angiography ◽  
Computational Modelling ◽  
Poor Correlation ◽  
Educational Tool ◽  
Loss Assessment ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Complex Anatomy ◽  
Coronary Stenoses ◽  
Coronary Lesions

Objective: Invasive coronary angiography remains the cornerstone for evaluation of coronary stenoses despite there being a poor correlation between luminal loss assessment by coronary luminography and myocardial ischemia. This is especially true for coronary lesions deemed moderate by visual assessment. Coronary pressure-derived fractional flow reserve (FFR) has emerged as the gold standard for the evaluation of hemodynamic significance of coronary artery stenosis, which is cost effective and leads to improved patient outcomes. There are, however, several limitations to the use of FFR including the evaluation of serial stenoses. Method: In this article, we discuss the electronic-hydraulic analogy and the utility of simple electrical modelling to mimic the coronary circulation and coronary stenoses. We exemplify the effect of tandem coronary lesions on the FFR by modelling of a patient with sequential disease segments and complex anatomy. Results: We believe that such computational modelling can serve as a powerful educational tool to help clinicians better understand the complexity of coronary hemodynamics and improve patient care.

Abstract 20015: Value of Quantitative Atherosclerotic Plaque Assessment Using CCTA to Predict Lesion-specific Ischemia, Data from 407 Coronary Lesions

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ran Heo ◽  
Hyung-Bok Park ◽  
Nakazato Ryo ◽  
Iksung Cho ◽  
Heidi Gransar ◽  
...  
Keyword(s):  
Invasive Coronary Angiography ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Fractional Flow ◽  
Luminal Diameter ◽  
Computed Tomographic ◽  
Flow Reserve ◽  
Significant Difference ◽  
Coronary Lesions ◽  
Tomographic Angiography

Introduction: While coronary computed tomographic angiography (CCTA) demonstrates high diagnostic performance for identification and exclusion of high-grade anatomic stenosis, it is unable to effectively discriminate coronary lesions that causes ischemia. Hypothesis: To study whether quantitative assessment of CCTA offer incremental information for discrimination of lesion ischemia beyond stenosis measures. Methods: 252 consecutive patients with suspected or known coronary artery disease (CAD) from 17 centers in 5 countries were enrolled (mean age 63±9 years, 71% male). Patients underwent CCTA and invasive coronary angiography (ICA), with 407 coronary lesions interrogated by invasive fractional flow reserve (FFR) at the time of maximum hyperemia. For these coronary lesions, we evaluated % diameter stenosis (%DS), % area stenosis (%AS), minimal luminal diameter (MLD, mm), minimal luminal area (MLA, mm 2 ), and plaque burden at MLA by CCTA. Plaque burden (PB, %) was defined as (vessel area–lumen area)/vessel areaх100. Lesion-specific ischemia by FFR was defined as a value ≤0.8. Results: In quantitative analysis area under the receiver operating characteristic curves (AUC) value of %DS, %AS, MLD, MLA, and PB for prediction of ischemia were 0.72 (95% confidence interval (CI) 0.68-0.77, p<0.001), 0.73 (95% CI 0.68-0.77, p<0.001), 0.75 (95% CI 0.70-0.79, p<0.001), 0.75 (95% CI 0.70-0.79, p<0.001), and 0.77 (95% CI 0.73-0.81, p<0.001), respectively. PB showed significantly improved AUC when compared to % area stenosis (p=0.002). However, PB didn’t show incremental power over MLA (p=0.213). There also was no significant difference in AUC between MLA and % area stenosis (p=0.330) Conclusions: Quantitative plaque assessment using CCTA could predict lesion-specific ischemia with good discrimination. Plaque burden showed incremental value over % area stenosis for ischemia prediction.

scholarly journals Analysis of the muscle tissue of Wistar rats submitted to the sciatic nerve compression model and cryotherapy

2018 ◽  
Vol 16 (3) ◽  
Author(s):  
Jhenifer Karvat ◽  
Camila Mayumi Martin Kakihata ◽  
Lizyana Vieira ◽  
José Luis da Conceição Silva ◽  
Lucinéia de Fátima Chasko Ribeiro ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Muscle Tissue ◽  
Wistar Rats ◽  
Nerve Compression ◽  
Control Group ◽  
Functional Evaluation ◽  
Cross Sectional ◽  
Injury Group ◽  
Significant Difference ◽  
The Right

ABSTRACT Objective: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. Methods: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. Results: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. Conclusion: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.

scholarly journals CT Determination of Fractional Flow Reserve in Coronary Lesions

2016 ◽  
Vol 1 (3) ◽  
pp. 237-241 ◽  
Author(s):  
András Mester ◽  
Monica Chiţu ◽  
Nora Rat ◽  
Diana Opincariu ◽  
Lehel Bordi ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Computational Techniques ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Gold Standard Method ◽  
Flow Reserve ◽  
Ct Evaluation ◽  
Coronary Lesions

Abstract Invasively determined fractional flow reserve (FFR) represents the gold-standard method for the functional evaluation of coronary lesions. Coronary computed tomography angiography (CCTA) provides characterization of the coronary anatomy, with important morphological information on the atherosclerotic plaques, but does not offer a hemodynamic evaluation of coronary artery lesions. CT evaluation of FFR (FFRCT) is a new noninvasive diagnostic method, which provides anatomical and functional assessment of the whole coronary tree, based on computational techniques, with no more radiation or hyperemic agent administration compared with routine CCTA. Recent studies demonstrated the safety and accuracy of FFRCT and its therapeutic use and cost benefits in real-world clinical use.

Myocardial Perfusion Imaging in Takayasu Arteritis

2013 ◽  
Vol 40 (12) ◽  
pp. 2052-2060 ◽  
Author(s):  
Cloé Comarmond ◽  
Odile Dessault ◽  
Jean-Yves Devaux ◽  
Nathalie Costedoat-Chalumeau ◽  
Matthieu Resche-Rigon ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Takayasu Arteritis ◽  
Myocardial Scintigraphy ◽  
Significant Difference ◽  
High Prevalence ◽  
Quantitative Image ◽  
Coronary Artery Stenoses ◽  
Perfusion Defects ◽  
Myocardial Perfusion Defects

Objective.Myocardial perfusion defects using scintigraphy have been frequently observed in patients with Takayasu arteritis (TA) without coronary stenosis. The aim of our study was to evaluate coronary microcirculation in TA using thallium-201 (201Tl) myocardial scintigraphy and dipyridamole (DPM) as vasodilator agent.Methods.Twenty-five consecutive patients with TA were prospectively recruited. They were asymptomatic for cardiac issues and examined using 201Tl myocardial scintigraphy at rest and after coronary artery vasodilation with intravenous DPM. Factors associated with improvement in myocardial perfusion after DPM were identified in patients with TA.Results.Among 25 patients with TA, 21 (84%) had 201Tl myocardial perfusion defects and 4 (16%) had normal resting myocardial perfusion. Using a 17-segments model for quantitative image analysis, DPM significantly improved resting 201Tl myocardial perfusion in 14 patients (61%) versus 9 patients without improvement (39%). We were able to examine coronary artery stenoses in 11 patients, including 10 patients with thallium perfusion defects, and significant coronary artery stenoses were present in only 2 patients (18.2%). No significant difference was found in traditional cardiovascular risk factors between TA patients with or without improvement of myocardial perfusion after DPM. The absence of improvement in myocardial perfusion after DPM tended to be closely associated with specific features and prognostic factors of TA, such as aortic regurgitation at diagnosis, renovascular hypertension, longer duration of TA disease, and male sex.Conclusion.We found the significantly high prevalence of myocardial perfusion defects mostly improved after vasodilation with DPM, which may indicate the major role of microcirculatory dysfunction in myocardial ischemia in TA.

Abstract 13051: Nourin-dependent Mirna-137 : A Novel Early Diagnostic Biomarker for Unstable Angina Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Salwa A Elgebaly ◽  
Robert H Christenson ◽  
Hossam Kandil ◽  
Nashwa El-Khazragy ◽  
Laila Rashed ◽  
...  
Keyword(s):  
Gene Expression ◽  
Unstable Angina ◽  
Cell Damage ◽  
Invasive Coronary Angiography ◽  
Diagnostic Biomarker ◽  
Significant Difference ◽  
Early Biomarker ◽  
Artery Disease ◽  
Spearman’S Correlation ◽  
Early Diagnostic

Introduction: No blood biomarker exits that can diagnose Unstable Angina (UA) patients. Nourin is ischemia-dependent inflammatory mediator rapidly released by reversible ischemic myocardium “before” necrosis, and by necrotic cells. Using Nourin amino acid sequence, Bioinformatics analysis indicated that Nourin is likely regulated by miR-137; a marker of cell damage and a hypoxiaresponsive autophagy-signaling pathway linked to myocardial ischemia and coronary artery disease. Hypothesis: That the Nourin-dependent miR-137, is an early biomarker for UA patients when Troponin levels are below the decision limit. The underlying regulatory mechanism involves lncRCTB89H12.4 and mRNA-FTLH-17; also associated with ischemia. Methods: We measured serum gene expression profile of lnc-CTB89H12.4/miR-137 and mRNAFTHL- 17 in UA (n=30 - confirmed by invasive coronary angiography and negative Troponin) and STEMI (n=16) patients at presentation, and healthy volunteers (n=16). Results: Gene expression of miR-137 was up-regulated by 1,185-fold in UA (median=1,244.41) compared to healthy (1.05), and by 2.5-fold in STEMI (3,162.72) compared to UA (Fig. 1). Receiving Operator Characteristics (ROC) analysis revealed a statistically significant difference in miR-137 that discriminated UA from healthy controls with a test sensitivity & specificity of 96% & 93%, respectively. Diagnostic sensitivity was 75% & specificity was 83% for discriminating UA from STEMI. Additionally, Spearman’s correlation analysis revealed a significant association of miR-137 with lncRCTB89H12.4and mRNA-FTHL-17. The down-regulation of lncR-CTB89H12.4 after ischemia resulted in the up-regulation of miR-137 and activation of mRNA-FTLH-17. Conclusions: As a marker of cell damage, the Nourin-dependent miR-137 is a promising early diagnostic biomarker indicating UA patients and discriminating between UA and STEMI. Regulations appears to be from lncR-CTB89H12.4 and mRNA-FTLH-17.

Abstract P189: Factors Associated With Stenosis on Invasive Coronary Angiography for Persons Living With Human Immunodeficiency Virus (PLWH): The HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Andrew Furman ◽  
Robert Riestenberg ◽  
Anna Pawlowski ◽  
Daniel Schneider ◽  
Donald M Lloyd-Jones ◽  
...  
Keyword(s):  
Viral Load ◽  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Clinical Care ◽  
Invasive Coronary Angiography ◽  
Hiv Viral Load ◽  
Cvd Risk ◽  
Significant Difference ◽  
Stenosis Severity ◽  
Significant Coronary Stenosis

Background: Persons living with HIV (PLWH) have greater risks for atherosclerotic cardiovascular disease (ASCVD) than uninfected persons. However, data are sparse regarding HIV-specific factors associated with coronary atherosclerosis. Methods: HIVE-4CVD is an electronic data repository of demographic and clinical data collected during the routine clinical care of 5041 PLWH and 10082 uninfected controls frequency matched on age, sex, race, zip code, and clinic location receiving care at Northwestern Medicine from 1/1/2000 to 5/17/2017. Using validated natural language extraction algorithms, we analyzed data on coronary stenosis severity for the 286 PLWH and 266 uninfected controls in HIVE-4CVD who underwent coronary angiography. Stenosis severity was recorded as the highest percentage of stenosis noted for each patient in each artery (LAD, LCx, RCA). Multivariable logistic regression models adjusted for demographics and CVD risk factors were used to evaluate odds of significant (≥50%) coronary stenosis (1) for PLWH versus uninfected controls and (2) across different levels of HIV viremia and immune suppression among PLWH. Results: Of the 286 PLWH and 266 uninfected controls undergoing coronary angiography, 205 (55.4%) PLWH vs. 165 (44.6%) uninfected controls had diagnoses of myocardial infarction (p=0.02). The location and severity of coronary stenoses did not differ significantly for PLWH vs. uninfected controls; mean maximal overall stenosis and mean maximal LAD, RCA, and LCx stenoses were 52.3% vs. 50.2% (p=0.52), 44.5% vs. 42.3% (p=0.48), 37.0% vs. 36.1% (p=0.78) and 31.4% vs. 31.6% (p=0.95) respectively. There was no significant difference in odds of having significant coronary stenosis for PLWH vs. uninfected controls (multivariable-adjusted OR 1.15, 95% CI 0.79-1.70). Among PLWH, peak HIV viral load was associated with borderline significantly greater odds of ≥50% coronary stenosis after adjustment for demographics, CVD risk factors, and HIV therapies (OR 1.07 per 10-fold greater peak HIV viral load, 95% CI 1.00-1.14, p=0.04), but lower Nadir CD4+ T cell count (<200 vs. ≥200 cells/mm 3 ) was not (OR 1.05, 95% CI 0.74-1.48, p=0.79). Conclusions: There was no consistent or significant difference in severity of coronary artery stenosis among PLWH and uninfected controls undergoing invasive coronary angiography in the course of routine clinical care. Higher peak HIV viral load is associated with borderline significantly greater odds of having significant coronary stenosis among PLWH undergoing invasive coronary angiography.

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