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Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Coronary artery calcium (CAC) is a well-established predictor of clinical outcomes for population screening. Limited evidence is available as to its predictive value in symptomatic patients without obstructive coronary artery disease (CAD). The aim of the current study was to assess the prognostic value of CAC scores among symptomatic patients with nonobstructive CAD.

Methods

From the COronary Computed Tomographic Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 7,200 symptomatic patients with nonobstructive CAD (<50% coronary stenosis) on coronary-computed tomographic angiography were prospectively enrolled and followed for a median of 2.1 years. Patients were categorized as without (0% stenosis) or with (>0% but <50% coronary stenosis) a luminal stenosis. CAC scores were calculated using the Agatston method. Univariable and multivariable Cox proportional hazard models were employed to estimate all-cause mortality and/or myocardial infarction (MI). Four-year death and death or MI rates were 1.9% and 3.3%.

Results

Of the 4,380 patients with no luminal stenosis, 86% had CAC scores of <10 while those with a luminal stenosis had more prevalent and extensive CAC with 31.9% having a CAC score of ≥100. Among patients with no luminal stenosis, CAC was not predictive of all-cause mortality (P = .44). However, among patients with a luminal stenosis, 4-year mortality rates ranged from 0.8% to 9.8% for CAC scores of 0 to ≥400 (P < .0001). The mortality hazard was 6.0 (P = .004) and 13.3 (P < .0001) for patients with a CAC score of 100-399 and ≥400. In patients with a luminal stenosis, CAC remained independently predictive in all-cause mortality (P < .0001) and death or MI (P < .0001) in multivariable models containing CAD risk factors and presenting symptoms.

Conclusions

CAC allows for the identification of those at an increased hazard for death or MI in symptomatic patients with nonobstructive disease. From the CONFIRM registry, the extent of CAC was an independent estimator of long-term prognosis among symptomatic patients with luminal stenosis and may further define risk and guide preventive strategies in patients with nonobstructive CAD.

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Author information

Authors and Affiliations

  1. Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, GA, USA

    Sana Shah MD, Naveen Bellam MD, Arshed Quyyumi MD & Leslee J. Shaw PhD

  2. Department of Radiology, St Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Jonathon Leipsic MD

  3. Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Daniel S. Berman MD, Millie J. Gomez MD & James K. Min MD

  4. Division of Cardiology, Technische Universität München, Munich, Germany

    Jörg Hausleiter MD

  5. Department of Medicine, University of Giessen, Giessen, Germany

    Stephan Achenbach MD

  6. Department of Medicine, King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia

    Mouaz Al-Mallah MD

  7. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA

    Matthew J. Budoff MD

  8. Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy

    Fillippo Cademartiri MD

  9. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA

    Tracy Q. Callister MD

  10. Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea

    Hyuk-Jae Chang MD

  11. Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada

    Benjamin J. W. Chow MD

  12. Baptist Hospital of Miami and Baptist Cardiac and Vascular Institute, Miami, FL, USA

    Ricardo C. Cury MD

  13. Capital Cardiology Associates, Albany, NY, USA

    Augustin J. Delago MD

  14. Department of Public Health and Medicine, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA

    Allison L. Dunning MS & Fay Y. Lin MD

  15. Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria

    Gudrun M. Feuchtner MD

  16. German Heart Center, Munich, Germany

    Martin Hadamitzky MD

  17. Cardiovascular Medical Group, Beverly Hills, CA, USA

    Ronald P. Karlsberg MD & Philipp A. Kaufmann MD

  18. Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA

    Kavitha M. Chinnaiyan MD & Gilbert L. Raff MD

  19. Cardiac Imaging, University Hospital, Zurich, Switzerland

    Erica Maffei MD

  20. Department of Medicine, Walter Reed Medical Center, Washington, DC, USA

    Todd C. Villines MD

Authors
  1. Sana Shah MD
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  2. Naveen Bellam MD
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  8. Mouaz Al-Mallah MD
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  28. Leslee J. Shaw PhD
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Consortia

for the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry) Investigators

Corresponding author

Correspondence to Leslee J. Shaw PhD.

Additional information

This registry was performed independently by the participating institutions and without any grant or in-kind support from any equipment or pharmaceutical manufacturer.

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Shah, S., Bellam, N., Leipsic, J. et al. Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease. J. Nucl. Cardiol. 21, 453–466 (2014). https://doi.org/10.1007/s12350-014-9865-9

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  • DOI: https://doi.org/10.1007/s12350-014-9865-9

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