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Coronary artery calcium associated with adverse events in patients with non-obstructive coronary heart disease in the SCOT-HEART Study.
Session:
Painel 3 - Imagiologia Cardiovascular 5
Speaker:
José Lopes De Almeida
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Posters
FP Number:
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Authors:
José Lopes De Almeida; Maria Ferreira; Rui Baptista; Sofia S. Martinho; João André Ferreira; Lino Gonçalves; Michelle Williams; David Newby
Abstract
<p><strong>INTRODUCTION:</strong></p> <p>Coronary CT Angiography (CCTA) has prognostic value in patients with symptoms concerning coronary heart disease (CHD). Coronary artery calcium (CAC) score has also an established prognostic value in both asymptomatic and symptomatic individuals. Recently, adverse coronary plaque characteristics were shown to confer an increased risk of CHD death or nonfatal myocardial infarction, but these associations were not independent of CAC score. The aim of this study was to assess if CAC score adds prognostic information to the anatomical information given by CCTA, particularly in the non-obstructive CHD patients for which evidence based management is scarcer.</p> <p><strong>METHODS:</strong></p> <p>A secondary analysis was performed in SCOT-HEART dataset. We analyzed patients who performed a baseline diagnostic CCTA (n=1772) and were classified into: no significant CHD (n=641), non-obstructive CHD (n=679) or obstructive CHD (n=452). Primary endpoint was 3-point MACE defined as a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death at 5 years.</p> <p>Cox multivariate regression was used to estimate the primary endpoint using CAC score risk class (Low Risk (<100 Agatston units (AU)), Medium Risk (100-400 AU), High Risk (>400 AU)) on top of CCTA anatomical classification.</p> <p><strong>RESULTS:</strong></p> <p>The CCTA anatomical diagnosis of CHD strongly predicted the primary endpoint (log rank p=0.0001). The majority of patients were diagnosed with non-obstructive CHD (38%), closely followed by no significant CHD (36%) and finally obstructive CHD (26%).</p> <p>In our model, CAC score further predicts MACE in addition to anatomic CCTA diagnosis (log rank p=0.014).</p> <p>Patients with high CAC score and non-obstructive (n=88) or obstructive (n=234) CHD had the worse prognosis, followed by patients with obstructive CHD and medium (n=124) or low (n=94) CAC score. Patients with non-obstructive CHD and either a medium (n=122) or low (n=108) CAC score had an intermediate prognosis. Finally, patients with no significant CHD and a low CAC score (n=640) had the best prognosis. Interestingly, there were no patients with no significant CHD and a high CAC score (n=0) and only one (n=1) had a medium CAC score (Figure 1).</p> <p><strong>CONCLUSIONS:</strong></p> <p>Combining anatomical information with CAC score, both obtainable through CCTA, has prognostic implications. Non-obstructive CHD has an overall good prognosis when associated low or medium CAC scores, but the worst prognosis if associated with a high CAC score.</p>
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