Non-obstructive coronary artery disease upon multi-detector computed tomography in patients presenting with acute chest pain-Results of an intermediate term follow-up

Segev, Amit; Beigel, Roy; Goitein, Orly; Brosh, Sella; Oiero, Dan; Konen, Eli; Hod, Hanoch; Matetzky, Shlomi

doi:10.1093/ejechocard/jer189

Cited by 9 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This sub-study demonstrated that those patients had an adverse prognosis with no significant difference in outcome between troponin-positive patients with CAD compared with those without CAD ( P = 0.20) [ 16 , 19 ]. However, this was in contrary to the previous study by Segev et al [ 17 ] which showed that the patients with non-obstructive CAD had a benign clinical outcome compared with those with normal coronary arteries during an intermediate term follow-up of 2.5 years with equal low MACE rate between the two groups. (1% for both groups; P = 0.9) [ 17 ].…”

Section: Discussioncontrasting

confidence: 94%

“…However, this was in contrary to the previous study by Segev et al [ 17 ] which showed that the patients with non-obstructive CAD had a benign clinical outcome compared with those with normal coronary arteries during an intermediate term follow-up of 2.5 years with equal low MACE rate between the two groups. (1% for both groups; P = 0.9) [ 17 ].…”

Section: Discussioncontrasting

confidence: 94%

“…Elevation of troponin in these patients may result from coronary atherothrombosis not evident using standard angiography or from other ischemic and non-ischemic mechanisms [ 16 ]. It was also previously shown that the incidental troponin rise was more common in older patients and was associated with a poorer prognosis compared to ACSs [ 17 ]. Given this substantially increased risk for adverse outcomes, patients with troponin elevation in general require appropriate diagnostic evaluation and therapy aimed at the underlying disorder [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prognosis of Troponin-Positive Patients with Non-Obstructive Coronary Artery Disease

et al. 2014

View full text Add to dashboard Cite

IntroductionTroponin elevation is an independent risk factor for mortality, but the prognosis of patients with troponin elevation and non-obstructive coronary artery disease (CAD) is unknown. Recent data have suggested an increased risk of mortality. This study was performed to further investigate the outcomes of troponin-positive patients with obstructive and non-obstructive CAD.MethodsA retrospective cohort analysis was performed of all patients with raised troponin presenting to Kettering General Hospital (January 2010 to December 2011, n = 1,351). The patients who had angiograms were stratified anatomically into obstructive CAD and non-obstructive CAD (≤50% stenosis). The obstructive CAD group (O-CAD) was sub-analyzed by management strategy: emergency re-vascularization (<12 h), urgent, delayed, and medically managed. Patients with non-obstructive CAD were grouped by the cause of the raised troponin if this could be identified (NO-CAD-I) or cause remained unidentified (NO-CAD-U). The major adverse cardiac and cerebrovascular event (MACCE) and mortality rates were calculated at 30 days and 1-year follow-up.ResultsThere was a preponderance of hypertension and severe renal impairment in the non-obstructive CAD group. The patients with NO-CAD-U were a low-risk group (MACCE at 1-year follow-up = 0). The remaining NO-CAD-I group had a similar risk to the O-CAD group for MACCE and mortality at 30 days and 1-year follow-up. In fact, at 1-year follow-up, the NO-CAD-I patients when compared with the subgroups of O-CAD, had higher MACCE rates and mortality compared with the emergency re-vascularized group [MACCE: relative risk (RR) (95% CI) = 2.27 (1.29–3.40), P = 0.0047; mortality: RR (95% CI) = 2.08 (1.10–3.93), P = 0.024]. This was driven by higher risk non-cardiac death [RR (95% CI) = 4.10 (1.53–10.99), P = 0.005].ConclusionPatients with identified cause for raised troponin and non-obstructive CAD are at equivalent risk of MACCE and mortality at 30 days and 1-year follow-up compared to those with obstructive CAD.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-014-0027-6) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussioncontrasting

confidence: 94%

Section: Discussioncontrasting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognosis of Troponin-Positive Patients with Non-Obstructive Coronary Artery Disease

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Although some studies are conflicting, the majority of cardiac CT studies suggest a significant, progressive increase in the risk of major adverse cardiac events with increasing extent of CAD. 33–36 Our study complements these findings by demonstrating the association between nonobstructive CAD and adverse cardiac outcomes using the predominant method of CAD diagnosis in current clinical practice—coronary angiography.…”

Section: Discussionsupporting

confidence: 60%

Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction

Maddox

Stanislawski

Grunwald

et al. 2014

JAMA

475

285

View full text Add to dashboard Cite

IMPORTANCE Little is known about cardiac adverse events among patients with nonobstructive coronary artery disease (CAD). OBJECTIVE To compare myocardial infarction (MI) and mortality rates between patients with nonobstructive CAD, obstructive CAD, and no apparent CAD in a national cohort. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of all US veterans undergoing elective coronary angiography for CAD between October 2007 and September 2012 in the Veterans Affairs health care system. Patients with prior CAD events were excluded. EXPOSURES Angiographic CAD extent, defined by degree (no apparent CAD: no stenosis >20%; nonobstructive CAD: ≥1 stenosis ≥20% but no stenosis ≥70%; obstructive CAD: any stenosis ≥70% or left main [LM] stenosis ≥50%) and distribution (1,2, or 3 vessel). MAIN OUTCOMES AND MEASURES The primary outcome was 1-year hospitalization for nonfatal MI after the index angiography. Secondary outcomes included 1-year all-cause mortality and combined 1-year MI and mortality. RESULTS Among37 674 patients, 8384 patients (22.3%) had nonobstructive CAD and 20 899 patients (55.4%) had obstructive CAD. Within 1 year, 845 patients died and 385 were rehospitalized for MI. Among patients with no apparent CAD, the 1-year MI rate was 0.11% (n = 8, 95% CI, 0.10%–0.20%) and increased progressively by 1-vessel nonobstructive CAD, 0.24% (n = 10, 95% CI, 0.10%–0.40%); 2-vessel nonobstructive CAD, 0.56% (n = 13, 95% CI, 0.30%–1.00%); 3-vessel nonobstructive CAD, 0.59% (n = 6, 95% CI, 0.30%–1.30%); 1-vessel obstructive CAD, 1.18% (n = 101, 95% CI, 1.00%–1.40%); 2-vessel obstructive CAD, 2.18% (n = 110, 95% CI, 1.80%–2.60%); and 3-vessel or LM obstructive CAD, 2.47% (n = 137, 95% CI, 2.10%–2.90%). After adjustment, 1-year MI rates increased with increasing CAD extent. Relative to patients with no apparent CAD, patients with 1-vessel nonobstructive CAD had a hazard ratio (HR) for 1-year MI of 2.0 (95% CI, 0.8–5.1); 2-vessel nonobstructive HR, 4.6 (95% CI, 2.0–10.5); 3-vessel nonobstructive HR, 4.5 (95% CI, 1.6–12.5); 1-vessel obstructive HR, 9.0 (95% CI, 4.2–19.0); 2-vessel obstructive HR, 16.5 (95% CI, 8.1–33.7); and 3-vessel or LM obstructive HR, 19.5 (95% CI, 9.9–38.2). One-year mortality rates were associated with increasing CAD extent, ranging from 1.38% among patients without apparent CAD to 4.30% with 3-vessel or LM obstructive CAD. After risk adjustment, there was no significant association between 1- or 2-vessel nonobstructive CAD and mortality, but there were significant associations with mortality for 3-vessel nonobstructive CAD (HR, 1.6; 95% CI, 1.1–2.5), 1-vessel obstructive CAD (HR, 1.9; 95% CI, 1.4–2.6), 2-vessel obstructive CAD (HR, 2.8; 95% CI, 2.1–3.7), and 3-vessel or LM obstructive CAD (HR, 3.4; 95% CI, 2.6–4.4). Similar associations were noted with the combined outcome. CONCLUSIONS AND RELEVANCE In this cohort of patients undergoing elective coronary angiography, nonobstructive CAD, compared with no apparent CAD, was associated with a significantly greater 1-year risk of MI...

show abstract

“…The study cohort included individuals who were admitted to the chest pain unit of our tertiary medical center for chest pain evaluation during 2006-2007. Patients underwent cardiac CT including a gated non-contrast scan (coronary Calcium Score scan) and a dedicated cardiac CT scan as previously described (11), which was also used for identifying patients with DISH.…”

Section: Patientsmentioning

confidence: 99%

No correlation between diffuse idiopathic skeletal hyperostosis and coronary artery disease on computed tomography using two different scoring systems

et al. 2022

View full text Add to dashboard Cite

Background An association between diffuse idiopathic skeletal hyperostosis (DISH) and a history of coronary artery disease (CAD) was previously reported. Purpose To investigate the association between DISH and CAD as assessed using the coronary artery calcification score (CACS) and the CAD-Reporting and Data System (CAD-RADS) score in patients with symptomatic chest pain. Material and Methods Consecutive cardiac CT scans performed before and after IV contrast administration were evaluated for CACS (Agatston method), CAD-RADS, and the presence of DISH. The association of DISH with the presence and extent of CACS/CAD-RADS scores was analyzed with and without adjustment for known atherosclerotic risk factors. Results The study cohort included 268 individuals (157 men, 111 women; median age = 54 years). DISH was present in 65 (24.3%) individuals. CACS was significantly higher in the DISH group compared to the non-DISH group in the univariate analysis (median CACS DISH = 2, range = 0–80.5 vs. median CACS non-DISH = 0, range = 0–11; P < 0.005) but this association did not persist on multivariate analysis. There was a positive trend toward higher CAD-RADS scores in the DISH group ( P = 0.03) but after adjustment for age, male sex, and family history, this tendency was not significant. Conclusion No independent association was found between the presence of DISH and CACS and CAD-RADS scores. Our findings suggest a more complex and possibly non-causal relationship between coronary artery disease and DISH.

show abstract

Non-obstructive coronary artery disease upon multi-detector computed tomography in patients presenting with acute chest pain-Results of an intermediate term follow-up

Abstract: Among patients evaluated by MDCT for acute chest pain, during an intermediate term follow-up, those with non-obstructive CAD had a benign clinical outcome compared with those with normal coronary arteries.

Cited by 9 publications

References 18 publications

Prognosis of Troponin-Positive Patients with Non-Obstructive Coronary Artery Disease

Prognosis of Troponin-Positive Patients with Non-Obstructive Coronary Artery Disease

Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction

No correlation between diffuse idiopathic skeletal hyperostosis and coronary artery disease on computed tomography using two different scoring systems

Contact Info

Product

Resources

About