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Risk stratification of non-obstructive coronary artery disease for guidance of preventive medical therapy

 In-Chang Hwang  ;  Heesun Lee  ;  Yeonyee E. Yoon  ;  In-Soon Choi  ;  Hack-Lyoung Kim  ;  Hyuk-Jae Chang  ;  Ja Youn Lee  ;  Jin A. Choi  ;  Hyo Jeong Kim  ;  Goo-Yeong Cho  ;  Jun-Bean Park  ;  Seung-Pyo Lee  ;  Hyung-Kwan Kim  ;  Yong-Jin Kim  ;  Dae-Won Sohn 
 ATHEROSCLEROSIS, Vol.290 : 66-73, 2019 
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Aspirin ; Coronary CT angiography ; Non-obstructive coronary artery disease ; Risk stratification ; Statin
BACKGROUND AND AIMS: Given the potential benefit of medical therapy in patients with non-obstructive coronary artery disease (CAD), there is a need for risk stratification and treatment strategy for these patients. We aimed to develop a risk prediction model for non-obstructive CAD patients for risk stratification and guidance of statin and aspirin therapy.

METHODS: From a cohort of consecutive patients who underwent coronary computed tomography angiography (CCTA) (n = 25,087), we identified patients with non-obstructive CAD of 1-49% diameter-stenosis (n = 6243) and developed a risk prediction model for 5-year occurrence of a composite of all-cause mortality, myocardial infarction, and late coronary revascularization using a derivation cohort (n = 4391).

RESULTS: Age, sex, hypertension, diabetes, anemia, C-reactive protein, and the extent of non-obstructive CAD were incorporated in the prediction model (risk score 0-13, C-index = 0.716). Patients were categorized into 4 groups; risk score of 0-3 (low-risk), 4-6 (intermediate-risk), 7-9 (high-risk), and ≥10 (very high-risk). Patients with very high-risk demonstrated unfavorable outcome comparable to patients with obstructive CAD. The low-risk group exhibited favorable outcome similar to those with no CAD. While statin therapy was associated with better outcomes in high- or very high-risk group (hazard ratio, 0.62; 95% confidence interval, 0.39-0.96; p = 0.033), aspirin use was associated with an increased risk in low-risk group (hazard ratio, 2.57; 95% confidence interval, 1.34-4.90; p = 0.004).

CONCLUSIONS: A dedicated risk scoring system for non-obstructive CAD using clinical factors and CCTA findings accurately predicted prognosis. According to our risk prediction model, statin therapy can be beneficial for high-risk patients, whereas aspirin can be harmful for low-risk patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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