Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study

Abstract

Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…Documented MACE rates in stable INOCA patients are summarized in Table 1 4, 10, 15, 26, 35, 36, 37, 38, 39, 40, 41. Additionally, many of these patients have an adverse quality of life, functional status, and exercise capacity with relatively frequent visits to healthcare providers for persistent or recurring disabling symptoms 42.…”

“…4, 41, 47 Specifically, in the Veterans Administration—Clinical Assessment, Reporting and Tracking System, patients with nonobstructive CAD in 3 coronary arteries had a similar annual risk for MI and death as patients with single‐vessel obstructive CAD 4. Risk was related not only to the degree of luminal stenosis but also to the extent of the angiographic disease, increasing with the number of vessels affected in both nonobstructive and obstructive disease 4, 47…”

“…CAD indicates coronary artery disease; MACE , major adverse cardiovascular events; NCA , normal coronary arteries; NOCAD , nonobstructive coronary artery disease. Outcomes include: Sharaf47: cardiovascular death or nonfatal MI ; Maddox4: all‐cause mortality or nonfatal MI ; Nielsen41: all‐cause death, MI , late coronary revascularization; Kenkre18: cardiac mortality; Kenkre18*, all‐cause death.…”

“…In women evaluated for signs and symptoms of ischemia undergoing clinically ordered coronary angiography in the WISE project, a pretest clinical score and an exercise test score designed for use in women with suspected CAD performed better than the commonly used Duke score in stratifying women with a low prevalence of obstructive CAD 41, 55…”

“…15, 41, 47, 72, 73, 74, 75, 76, 77 Furthermore, the intensity of treatment, specifically for the maximally tolerated angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker and potent statin categories, is unknown in these registries. These findings suggest that the presence of normal coronary arteries or NOCAD at coronary angiography may be associated with diagnostic and therapeutic uncertainty, resulting in patients being less often treated with either primary prevention or secondary prevention guidelines therapy.…”