Prognostic Implications of Nonobstructive Coronary Artery Disease in Patients Undergoing Coronary Computed Tomographic Angiography for Acute Chest Pain

Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging – Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque

“…Figure 1 provides a synthesis of available evidence, noting that nearly 1 in 3 patients referred for CCTA for suspected CAD will have nonobstructive CAD. [9][10][11][12][13][14]3,[15][16][17][18][19][20][21][22][23] One-third of patients referred to CCTA have nonobstructive CAD while ~10-15% of patients have obstructive CAD. 24 The annualized event rate for patients with nonobstructive CAD is ~1.6% as compared to 0.2% for those with a normal CCTA.…”

“…The adjusted hazard for MACE for nonobstructive CAD as compared to a normal CCTA ranged from 1.5 to 7.2; when controlling for CAD risk factors or a risk score. [9][10][11][12][13][14]3,[15][16][17][18][19][20][21][22][23] Thus, a first step for all CT imagers to comprehend that identification of nonobstructive plaque is an important aspect of identifying at-risk patients. One commonly reported measure is the semi-quantitative assessment of the number of coronary segments with plaque, independent of the stenosis severity, using the segment involvement score (SIS).…”

Adverse Cardiac Events Risks of Non-Obstructive Coronary Artery Disease by Cardiac CT Angiography at One-Year Follow-Up: Results of the Coronary Risk Determination in Intermediate Stratum Coronary CT Angiography (CORDISC) Study

“…This finding, not reported in the literature, may be explained by the fact that our institution is a referral center for patients with congenital heart diseases in the health system. To the best of our knowledge, this is one of the largest single center studies to investigate the oneyear clinical outcomes of cardiac CT-defined non-obstructive CAD using a real-time prospectively collected database with further delineation of the different etiologies of observed MACE [1,[11][12][13][16][17][18] .…”

“…Cardiac computed tomography (CT) has been a useful noninvasive modality to assess coronary artery disease (CAD) in intermediate risk patients with a high negative predictive value [1][2][3] . Its high diagnostic performance has been demonstrated in a meta-analysis with a sensitivity and specificity of 97.2% and 87.4%, respectively [2] .…”

Personality subtypes and chest pain in patients with nonobstructive coronary artery disease from the TweeSteden Mild Stenosis study: mediating effect of anxiety and depression

“…In up to 60% of patients undergoing coronary angiography (CAG), no significant obstructive coronary artery disease (CAD) is detected, and these patients with nonobstructive CAD are treated conservatively (Bugiardini and Bairey Merz, 2005;Cannon, 2009;Maddox et al, 2010;Vaccarino et al, 2013). Still, chest pain in patients with normal or near normal coronary arteries is prevalent and recurrent (Jespersen et al, 2013;Mommersteeg et al, 2013), related to increased clinical examinations (Beigel et al, 2013;Rossini et al, 2013), hospitalization (Rossini et al, 2013), major adverse cardiac events (Bugiardini and Bairey Merz, 2005;Jespersen et al, 2012) and mortality (Jespersen et al, 2012;Rossini et al, 2013;Sharaf et al, 2013), which requires further investigation.…”