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