Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

Alexander R van Rosendael; A Maxim Bax; Inge J van den Hoogen; Jeff M Smit; Subhi J Al'Aref; Stephan Achenbach; Mouaz H Al-Mallah; Daniele Andreini; Daniel S Berman; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo C Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A Kaufmann; Yong-Jin Kim; Jonathon A Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L Raff; Ronen Rubinshtein; Todd C Villines; Heidi Gransar; Yao Lu; Jessica M Peña; Fay Y Lin; Leslee J Shaw; Jagat Narula; James K Min; Jeroen J Bax

doi:10.1093/ehjci/jeaa323

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Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

Authors: Alexander R van Rosendael ; A Maxim Bax ; Inge J van den Hoogen ; Jeff M Smit ; Subhi J Al'Aref ; Stephan Achenbach ; Mouaz H Al-Mallah ; Daniele Andreini ; Daniel S Berman ; Matthew J Budoff ; Filippo Cademartiri ; Tracy Q Callister ; Hyuk-Jae Chang ; Kavitha Chinnaiyan ; Benjamin J W Chow ; Ricardo C Cury ; Augustin DeLago ; Gudrun Feuchtner ; Martin Hadamitzky ; Joerg Hausleiter ; Philipp A Kaufmann ; Yong-Jin Kim ; Jonathon A Leipsic ; Erica Maffei ; Hugo Marques ; Pedro de Araújo Gonçalves ; Gianluca Pontone ; Gilbert L Raff ; Ronen Rubinshtein ; Todd C Villines ; Heidi Gransar ; Yao Lu ; Jessica M Peña ; Fay Y Lin ; Leslee J Shaw ; Jagat Narula ; James K Min ; Jeroen J Bax

Citation: EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol.23(2) : 266-274, 2022-01

Journal Title: EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING

ISSN: 2047-2404

Issue Date: 2022-01

MeSH: Aged ; Coronary Angiography / methods ; Coronary Artery Disease* / complications ; Coronary Artery Disease* / diagnostic imaging ; Dyspnea ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Registries ; Risk Factors

Keywords: coronary artery disease ; coronary computed tomography angiography ; dyspnoea ; prognosis

Abstract: Aims: The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea.

Methods and results: From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD.

Conclusion: In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.