title: Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events.
abstract: BACKGROUND
  The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography.
  
  
  RESULTS
  All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (<50% stenosis), or obstructive (≥50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (≤4 segments) or extensive (>4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1-5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5-6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3-6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2-7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction.
  
  
  CONCLUSIONS
  Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment.
authors.affiliation: Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Marcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.forename: Edward
authors.initials: E
authors.lastname: Hulten
authors.forename: Brian
authors.initials: B
authors.lastname: Ghoshhajra
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Leary
authors.forename: Mitalee P
authors.initials: MP
authors.lastname: Christman
authors.forename: Philip
authors.initials: P
authors.lastname: Montana
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Michael
authors.initials: M
authors.lastname: Steigner
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Luis Henrique W
authors.initials: LH
authors.lastname: Gowdak
authors.forename: Jon
authors.initials: J
authors.lastname: Hainer
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: coronary artery disease; prognosis; risk assessment