Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis.

Autor:	Mortensen MB; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: martin.bodtker.mortensen@clin.au.dk., Dzaye O; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Steffensen FH; Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark., Bøtker HE; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Jensen JM; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Rønnow Sand NP; Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark., Kragholm KH; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Sørensen HT; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark., Leipsic J; St Pauls Hospital, UBC, Vancouver, British Columbia, Canada., Mæng M; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Blaha MJ; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Nørgaard BL; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2020 Dec 15; Vol. 76 (24), pp. 2803-2813.
DOI:	10.1016/j.jacc.2020.10.021
Abstrakt:	Background: Patients with obstructive coronary artery disease (CAD) are at high risk for cardiovascular disease (CVD) events. However, it remains unclear whether the high risk is due to high atherosclerotic disease burden or if presence of stenosis has independent predictive value. Objectives: The purpose of this study was to evaluate if obstructive CAD provides predictive value beyond its association with total calcified atherosclerotic plaque burden as assessed by coronary artery calcium (CAC). Methods: Among 23,759 symptomatic patients from the Western Denmark Heart Registry who underwent diagnostic computed tomography angiography (CTA), we assessed the risk of major CVD (myocardial infarction, stroke, and all-cause death) stratified by CAC burden and number of vessels with obstructive disease. Results: During a median follow-up of 4.3 years, 1,054 patients experienced a first major CVD event. The event rate increased stepwise with both higher CAC scores and number of vessels with obstructive disease (by CAC scores: 6.2 per 1,000 person-years (PY) for CAC = 0 to 42.3 per 1,000 PY for CAC >1,000; by number of vessels with obstructive disease: 6.1 per 1,000 PY for no CAD to 34.7 per 1,000 PY for 3-vessel disease). When stratified by 5 groups of CAC scores (0, 1 to 99, 100 to 399, 400 to 1,000, and >1,000), the presence of obstructive CAD was not associated with higher risk than presence of nonobstructive CAD. Conclusions: Plaque burden, not stenosis per se, is the main predictor of risk for CVD events and death. Thus, patients with a comparable calcified atherosclerosis burden generally carry a similar risk for CVD events regardless of whether they have nonobstructive or obstructive CAD. Competing Interests: Author Disclosures This study was funded by Aarhus University Hospital. Dr. Blaha has received grants from the National Institutes of Health, U.S. Food and Drug Administration, American Heart Association, and Aetna Foundation; has received grants and personal fees from Amgen; and has received personal fees from Sanofi, Regeneron, Novartis, Bayer, and NovoNordisk outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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