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Subclinical Coronary Atherosclerosis and Risk for MI
Quick Takes
- Among adults ≥40 years who were asymptomatic, coronary CTA findings of subclinical atherosclerosis were significantly associated with risk for MI.
- Obstructive atherosclerosis found on coronary CTA was associated with a higher risk for MI compared to nonobstructive atherosclerosis.
- The highest risk for MI was observed in people with obstructive-extensive subclinical coronary atherosclerosis or obstructive-nonextensive subclinical coronary atherosclerosis.
- The risk for the composite endpoint of death or MI was increased in persons with extensive disease, regardless of the degree of obstruction.
Study Questions:
What are the characteristics of subclinical coronary atherosclerosis associated with developing myocardial infarction (MI)?
Methods:
Data from the Copenhagen General Population Study (CGPS) were used for the present analysis. The CGPS was initiated in 2003 as a prospective observational cohort study. Coronary computed tomography angiography (CTA) was collected starting in 2010 among participants who were ≥40 years with normal renal function. Participants with known ischemic heart disease or who self-reported chest pain were excluded. Subclinical coronary atherosclerosis was assessed with coronary CTA. Coronary atherosclerosis was characterized according to luminal obstruction (nonobstructive or obstructive [≥50% luminal stenosis]) and extent (nonextensive or extensive [one-third or more of the coronary tree]). The primary outcome was MI, and the secondary outcome was a composite of death or MI.
Results:
A total of 9,533 asymptomatic adults were included in the present study, of which 5,114 (54%) persons had no subclinical coronary atherosclerosis, 3,483 (36%) had nonobstructive disease, and 936 (10%) had obstructive disease. During a median follow-up of 3.5 years (range, 0.1-8.9 years), 193 persons died, and 71 had an MI. The risk for MI was increased in persons with obstructive (adjusted relative risk [ARR], 9.19 [95% CI, 4.49-18.11]) and extensive (7.65 [CI, 3.53-16.57]) disease. The highest risk for MI was noted in persons with obstructive-extensive subclinical coronary atherosclerosis (ARR, 12.48 [CI, 5.50-28.12]) or obstructive-nonextensive (ARR, 8.28 [CI, 3.75-18.32]). The risk for the composite endpoint of death or MI was increased in persons with extensive disease, regardless of the degree of obstruction.
Conclusions:
The authors concluded that in asymptomatic persons, subclinical obstructive coronary atherosclerosis is associated with a >8-fold elevated risk for MI.
Perspective:
These data support the use of coronary CTA in patients as a risk stratification method. However, identification of patients who gain the highest benefit and best management for lowering CVD events is warranted. Among those with extensive subclinical coronary atherosclerosis, whether optimal risk factor management will lower the risk for MI remains to be determined. Additionally, cost-effectiveness and reproducibility among non-White and diverse socioeconomic populations will assist in understanding the value of coronary CTA as a diagnostic prevention tool.
Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging
Keywords: Angiography, Atherosclerosis, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Coronary Stenosis, Diagnostic Imaging, Myocardial Infarction, Primary Prevention, Risk Factors, Socioeconomic Factors, Tomography, Emission-Computed
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