Predictors of non-calcified plaque presence and future adverse cardiovascular events in symptomatic rural Appalachian patients with a zero coronary artery calcium score.
J Cardiovasc Comput Tomogr
; 17(5): 302-309, 2023.
Article
em En
| MEDLINE
| ID: mdl-37543447
ABSTRACT
BACKGROUND:
Coronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment.METHODS:
A retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years.RESULTS:
Based on logistic regression, age (OR 1.039, 95% CI [1.020-1.058], p â< â0.001), diabetes mellitus (OR 2.192, 95% CI [1.307-3.676], p â< â0.003), tobacco use (OR 1.748, 95% CI [1.157-2.643], p â< â0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003-1.015], p â< â0.002), and hypertension (OR 1.613, 95% CI [1.024-2.540], p â< â0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p â< â0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26-128.26], p â< â0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025-4.627], p â< â0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension.CONCLUSION:
NCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
/
Diabetes Mellitus
/
Placa Aterosclerótica
/
Hipertensão
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Cardiovasc Comput Tomogr
Ano de publicação:
2023
Tipo de documento:
Article