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DOES PROGNOSIS CHANGE DEPENDING ON NUMBER AND COMPOSITION OF NON OBSTRUCTIVE PLAQUES? RESULTS FROM THE MULTINATIONAL CORONARY CT ANGIOGRAPHY EVALUATION FOR CLINICAL OUTCOME: AN INTERNATIONAL MULTICENTER REGISTRY (CONFIRM)
A980 JACC April 1, 2014 Volume 63, Issue 12
Non Invasive Imaging Does Prognosis Change Depending on Number and Composition of Non Obstructive Plaques? Results from the Multinational Coronary CT Angiography Evaluation for Clinical Outcome: An International Multicenter Registry (CONFIRM) Moderated Poster Contributions Hall C Sunday, March 30, 2014, 10:00 a.m.-10:15 a.m.
Session Title: From Calcium to Plaque and Fat: Prognostic Value of CT Abstract Category: 18. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1202M-363B Authors: Amir Ahmadi, James Min, Adam Berger, Stephan Achenbach, Shalan Alaamri, Mouaz Al-Mallah, Daniel Berman, Matthew Budoff, Filippo Cademartiri, Tracy Callister, Hyuk-Jae Chang, Kavitha Chinnaiyan, Benjamin Chow, Ricardo Cury, Gudrun Feuchtner, Heidi Gransar, Martin Hadamitzky, Joerg Hausleiter, Philipp Kaufmann, Fay Lin, Gilbert Raff, Leslee Shaw, Todd Villines, Jonathon Leipsic, CONFIRM Investigators, University of British Columbia, Vancouver, Canada, Weill Cornell Medical College, New York, NY, USA Background: Obstructive coronary artery disease (CAD) has worse prognosis compare to non-obstructive CAD. However, non-obstructive plaques have been implicated in pathophysiology of sudden cardiac death and myocardial infarction (MI). It is not known whether there is an incremental risk of major adverse cardiac events (MACE) with increasing number of non-obstructive plaques or if that risk matches the risk of obstructive plaques. The purpose of this study is to examine prognosis associated with non-obstructive CAD stratified by its extent. Methods: 27,125 consecutive individuals who underwent 64-detector row coronary CT angiography (CCTA) for suspected CAD at 12 centers from 2003 to 2009 were included in our analysis. Patients with known CAD were excluded. Obstructive CAD group (n= 734) consisted of individuals with ≥ 70% stenosis. Non-obstructive CAD group (n=6522) consisted of patients with no obstructive plaques and presence of 1 to 5 non-obstructive (<70%) plaques. The non-obstructive CAD group was divided to subgroups based on number of plaques and plaque morphology. MACE was defined as MI, acute coronary syndrome, all cause mortality and late revascularization. MACE was assessed by risk-adjusted Cox proportional hazards models. Results: There were 196 MACE (2.70%) in the total study population over follow up of 2.2 years. The obstructive CAD group had higher annual MACE rate compared to non-obstructive CAD group (2.32% vs 1.54% p<0.001). There was an increase in annual MACE rate with increase in number of plaques in non-obstructive CAD subgroups with non-calcified plaques (PCP) or partially calcified plaques (PCP) (1.2%, 1.7%, %, 2.0%, 1.8% and 2.2% for 1, 2, 3, 4 and 5 non obstructive plaques, respectively (trend p=0.01)). Presence of 2 or more non-obstructive plaque with NCP or PCP morphology had similar MACE rate to that of the 1 or 2 obstructive plaques (p=0.25). Conclusion: There is an increase in risk of MACE with increase in number of NCP or PCP non-obstructive plaques. The risk of MACE with 2 or more of these plaques is similar to that of 1 or 2 obstructive plaques. These findings question the efficacy of risk stratification methods that solely detect presence of obstructive plaques.
Non Invasive Imaging Does Prognosis Change Depending on Number and Composition of Non Obstructive Plaques? Results from the Multinational Coronary CT Angiography Evaluation for Clinical Outcome: An International Multicenter Registry (CONFIRM) Moderated Poster Contributions Hall C Sunday, March 30, 2014, 10:00 a.m.-10:15 a.m.
Session Title: From Calcium to Plaque and Fat: Prognostic Value of CT Abstract Category: 18. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1202M-363B Authors: Amir Ahmadi, James Min, Adam Berger, Stephan Achenbach, Shalan Alaamri, Mouaz Al-Mallah, Daniel Berman, Matthew Budoff, Filippo Cademartiri, Tracy Callister, Hyuk-Jae Chang, Kavitha Chinnaiyan, Benjamin Chow, Ricardo Cury, Gudrun Feuchtner, Heidi Gransar, Martin Hadamitzky, Joerg Hausleiter, Philipp Kaufmann, Fay Lin, Gilbert Raff, Leslee Shaw, Todd Villines, Jonathon Leipsic, CONFIRM Investigators, University of British Columbia, Vancouver, Canada, Weill Cornell Medical College, New York, NY, USA Background: Obstructive coronary artery disease (CAD) has worse prognosis compare to non-obstructive CAD. However, non-obstructive plaques have been implicated in pathophysiology of sudden cardiac death and myocardial infarction (MI). It is not known whether there is an incremental risk of major adverse cardiac events (MACE) with increasing number of non-obstructive plaques or if that risk matches the risk of obstructive plaques. The purpose of this study is to examine prognosis associated with non-obstructive CAD stratified by its extent. Methods: 27,125 consecutive individuals who underwent 64-detector row coronary CT angiography (CCTA) for suspected CAD at 12 centers from 2003 to 2009 were included in our analysis. Patients with known CAD were excluded. Obstructive CAD group (n= 734) consisted of individuals with ≥ 70% stenosis. Non-obstructive CAD group (n=6522) consisted of patients with no obstructive plaques and presence of 1 to 5 non-obstructive (<70%) plaques. The non-obstructive CAD group was divided to subgroups based on number of plaques and plaque morphology. MACE was defined as MI, acute coronary syndrome, all cause mortality and late revascularization. MACE was assessed by risk-adjusted Cox proportional hazards models. Results: There were 196 MACE (2.70%) in the total study population over follow up of 2.2 years. The obstructive CAD group had higher annual MACE rate compared to non-obstructive CAD group (2.32% vs 1.54% p<0.001). There was an increase in annual MACE rate with increase in number of plaques in non-obstructive CAD subgroups with non-calcified plaques (PCP) or partially calcified plaques (PCP) (1.2%, 1.7%, %, 2.0%, 1.8% and 2.2% for 1, 2, 3, 4 and 5 non obstructive plaques, respectively (trend p=0.01)). Presence of 2 or more non-obstructive plaque with NCP or PCP morphology had similar MACE rate to that of the 1 or 2 obstructive plaques (p=0.25). Conclusion: There is an increase in risk of MACE with increase in number of NCP or PCP non-obstructive plaques. The risk of MACE with 2 or more of these plaques is similar to that of 1 or 2 obstructive plaques. These findings question the efficacy of risk stratification methods that solely detect presence of obstructive plaques.