Open AccessInfluence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)
Author(s) -
Lee Ji Hyun,
Han Donghee,
Hartaigh Bríain ó,
Gransar Heidi,
Lu Yao,
Rizvi Asim,
Park Mahn Won,
Roudsari Hadi Mirhedayati,
Stuijfzand Wijnand J.,
Berman Daniel S.,
Callister Tracy Q.,
DeLago Augustin,
Hadamitzky Martin,
Hausleiter Joerg,
AlMallah Mouaz H.,
Budoff Matthew J.,
Kaufmann Philipp A.,
Raff Gilbert,
Chinnaiyan Kavitha,
Cademartiri Filippo,
Maffei Erica,
Villines Todd C.,
Kim YongJin,
Leipsic Jonathon,
Feuchtner Gudrun,
Pontone Gianluca,
Andreini Daniele,
Marques Hugo,
Rubinshtein Ronen,
Achenbach Stephan,
Shaw Leslee J.,
Chang HyukJae,
Bax Jeroen,
Chow Benjamin,
Cury Ricardo C.,
Gomez Millie,
Jones Erica C.,
Lin Fay Y.,
Min James K.,
Peña Jessica M.
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22940
Subject(s) - medicine , mace , coronary artery disease , hazard ratio , cardiology , myocardial infarction , asymptomatic , confidence interval , angina , interquartile range , percutaneous coronary intervention
Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%–49%) and none (0%). Based upon the Diamond‐Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all‐cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow‐up of 5.3 years (interquartile range, 4.6–5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE ( P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06–2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34–1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.