Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)

• Type of Material: Article
• Authors: Ji Hyun Lee, New York–Presbyterian Hospital and Weill Cornell Medicine; Donghee Han, New York–Presbyterian Hospital and Weill Cornell Medicine; Brian O Hartaigh, New York–Presbyterian Hospital and Weill Cornell Medicine; Heidi Gransar, Myongji Hospital; Yao Lu, New York–Presbyterian Hospital and Weill Cornell Medicine; Asim Rizvi, New York–Presbyterian Hospital and Weill Cornell Medicine; Mahn Won Park, New York–Presbyterian Hospital and Weill Cornell Medicine; Hadi Mirhedayati Roudsari, New York–Presbyterian Hospital and Weill Cornell Medicine; Wijnand J. Stuijfzand, New York–Presbyterian Hospital and Weill Cornell Medicine; Daniel S. Berman, Cedars‐Sinai Medical Center; Tracy Q. Callister, Tennessee Heart and Vascular Institute; Augustin DeLago, Capitol Cardiology Associates; Martin Hadamitzky, German Heart Center; Joerg Hausleiter, Ludwig-Maximilians University; Mouaz H. Al-Mallah, King Saud Bin Abdulaziz University for Health Sciences; Matthew J. Budoff, Harbor UCLA Medical Center; Phillip A. Kaufmann, University Hospital Zurich; Gilbert Raff, William Beaumont Hospital; Kavitha Chinnaiyan, William Beaumont Hospital; Leslee J Shaw, Emory University
• Language: English
• Date: 2018-05-01
• Publisher: Wiley Open Access: Various Creative Commons Licenses
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/clc.22940
• Title of Journal or Parent Work: Clinical Cardiology
• ISSN: 0160-9289
• Volume: 41
• Issue: 5
• Start Page: 586
• End Page: 593
• Grant/Funding Information: 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); 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.
• Keywords: ARTERIOGRAMS; Coronary Computed Tomographic Angiography; Science & Technology; ANGINA-PECTORIS; RISK; Cardiac & Cardiovascular Systems; Major Adverse Cardiac Events; CARDIOVASCULAR EVENTS; Life Sciences & Biomedicine; CHEST-PAIN; CT; Symptom Typicality; Cardiovascular System & Cardiology; ACCURACY; Coronary Artery Disease; DIAGNOSTIC PERFORMANCE
• Research Categories: Health Sciences, Radiology; Health Sciences, Medicine and Surgery

Abstract

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.