title: Mortality risk in symptomatic patients with nonobstructive coronary artery disease: a prospective 2-center study of 2,583 patients undergoing 64-detector row coronary computed tomographic angiography.
abstract: OBJECTIVE
  We examined mortality risk in relation to extent and composition of nonobstructive plaques by 64-detector row coronary computed tomographic angiography (CCTA).
  
  
  BACKGROUND
  The prognostic significance of nonobstructive coronary artery plaques by CCTA is poorly understood.
  
  
  METHODS
  We prospectively evaluated consecutive adults from 2 centers undergoing 64-detector row CCTA without prior documented coronary artery disease (CAD) and without obstructive (≥50%) CAD by CCTA. Luminal diameter stenosis severity was classified for each segment as none (0%) or mild (1% to 49%), and plaque composition was classified as noncalcified, calcified, or mixed.
  
  
  RESULTS
  During 3.1 ± 0.5 years, 54 intermediate-term (≥90 days) deaths occurred among 2,583 patients (2.09%), with 4 early (<90 days) deaths. Adjusted for CAD risk factors, the presence of any nonobstructive plaque was associated with higher mortality (hazard ratio [HR]: 1.98, 95% confidence Interval [CI]: 1.06 to 3.69, p = 0.03), with the highest risk among those exhibiting nonobstructive CAD in 3 epicardial vessels (HR: 4.75, 95% CI: 2.10 to 10.75, p = 0.0002) or ≥5 segments (HR: 5.12, 95% CI: 2.16 to 12.10, p = 0.0002). Higher mortality for nonobstructive CAD was observed even among patients with low 10-year Framingham risk (3.4%, p < 0.0001) as well as those with no traditional, medically treatable CAD risk factors, including diabetes mellitus, hypertension, and dyslipidemia (6.7%, p < 0.0001). No independent relationship between plaque composition and incident mortality was observed. Importantly, patients without evident plaque experienced a low rate of incident death during follow-up (0.34%/year).
  
  
  CONCLUSIONS
  The presence and extent of nonobstructive plaques augment prediction of incident mortality beyond conventional clinical risk assessment.
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Allison M
authors.initials: AM
authors.lastname: Dunning
authors.forename: Troy M
authors.initials: TM
authors.lastname: Labounty
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
authors.forename: Sunaina
authors.initials: S
authors.lastname: Koduru
authors.forename: Millie J
authors.initials: MJ
authors.lastname: Gomez
authors.forename: Augustin J
authors.initials: AJ
authors.lastname: Delago
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000367:Age Factors; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed