Graded risk
The analysis included 9,533 persons aged 40 and older without known ischemic heart disease or symptoms with available CTA assessments.
Obstructive disease, defined as presence of a luminal stenosis of at least 50%, was seen in 10% and nonobstructive disease in 36% of the total cohort, the report states.
Disease occupying more than one-third of the coronary tree was considered extensive and less than one-third of the coronaries nonextensive, occurring in 10.5% and 35.8% of the cohort, respectively.
There were 71 MIs and 193 deaths over a median of 3.5 years. The adjusted relative risk for MI, compared with those without coronary atherosclerosis, was:
- 7.65 (95% confidence interval, 3.53-16.57) overall in patients with extensive disease.
- 8.28 (95% CI, 3.75-18.32) in those with obstructive but nonextensive disease.
- 9.19 (95% CI, 4.49-18.82) overall in those with obstructive disease.
- 12.48 (95% CI, 5.50-28.12) in those with or obstructive and extensive disease.
The adjusted RR for the composite of death or MI was also elevated in persons with extensive disease:
- 2.70 (95% CI, 1.72-4.25) in those with extensive but nonobstructive disease.
- 3.15 (95% CI, 2.05-4.83) in those with extensive and obstructive disease.
“It’s one thing to show that the more plaque, the higher the risk,” Dr. Blankstein said. But “does the information ultimately lead to better outcomes? Do patients have fewer MIs or fewer deaths?” Several ongoing randomized trials are exploring these questions.
They include DANE-HEART (Computed Tomography Coronary Angiography for Primary Prevention), projected to enroll about 6,000 participants from the Copenhagen General Population Study cohort who have at least one CV risk factor, and SCOT-HEART 2 (second Computed Tomography Coronary Angiography for the Prevention of Myocardial Infarction), enrolling a similar cohort in Scotland.
The study was supported by grants from AP Møller og Hustru Chastine Mc-Kinney Møllers Fond, the Research Council of Rigshospitalet, and Danish Heart Foundation. Dr. Fuchs reports no relevant financial relationships. Disclosures for the other authors can be found here. Dr. Blankstein recently disclosed serving as a consultant to Amgen, Caristo Diagnostics, Novartis, and Silence Therapeutics. Disclosures for Dr. McDermott and Dr. Newby, who are SCOT-HEART 2 investigators, can be found here.
A version of this article originally appeared on Medscape.com.