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Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)

 Ji Hyun Lee  ;  Donghee Han  ;  Bríain ó Hartaigh  ;  Heidi Gransar  ;  Yao Lu  ;  Asim Rizvi  ;  Mahn Won Park  ;  Hadi Mirhedayati Roudsari  ;  Wijnand J. Stuijfzand  ;  Daniel S. Berman  ;  Tracy Q. Callister  ;  Augustin DeLago  ;  Martin Hadamitzky  ;  Joerg Hausleiter  ;  Mouaz H. Al‐Mallah  ;  Matthew J. Budoff  ;  Philipp A. Kaufmann  ;  Gilbert Raff  ;  Kavitha Chinnaiyan  ;  Filippo Cademartiri  ;  Erica Maffei  ;  Todd C. Villines  ;  Yong‐Jin Kim  ;  Jonathon Leipsic  ;  Gudrun Feuchtner  ;  Gianluca Pontone  ;  Daniele Andreini  ;  Hugo Marques  ;  Ronen Rubinshtein  ;  Stephan Achenbach  ;  Leslee J. Shaw  ;  Hyuk‐Jae Chang  ;  Jeroen Bax  ;  Benjamin Chow  ;  Ricardo C. Cury  ;  Millie Gomez  ;  Erica C. Jones  ;  Fay Y. Lin  ;  James K. Min  ;  Jessica M. Peña 
 CLINICAL CARDIOLOGY, Vol.41(5) : 586-593, 2018 
Journal Title
Issue Date
Adult ; Aged ; Angina Pectoris/diagnostic imaging* ; Angina Pectoris/etiology* ; Angina Pectoris/mortality ; Angina, Unstable/diagnostic imaging ; Angina, Unstable/etiology ; Asia ; Asymptomatic Diseases ; Computed Tomography Angiography* ; Coronary Angiography/methods* ; Coronary Artery Disease/complications* ; Coronary Artery Disease/diagnostic imaging* ; Coronary Artery Disease/mortality ; Coronary Stenosis/complications* ; Coronary Stenosis/diagnostic imaging* ; Coronary Stenosis/mortality ; Europe ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multidetector Computed Tomography* ; Myocardial Infarction/diagnostic imaging ; Myocardial Infarction/etiology ; North America ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Registries ; Risk Factors ; Severity of Illness Index
Coronary Artery Disease ; Coronary Computed Tomographic Angiography ; Major Adverse Cardiac Events ; Symptom Typicality
Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%-49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6-5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06-2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34-1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jee Hyun(이지현)
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Han, Donghee(한동희)
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