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Browsing by Author "Lin, F"

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  • Prognostic Significance of Subtle Coronary Calcification in Patients with Zero Coronary Artery Calcium Score: From the CONFIRM Registry
    Publication . Han, D; Klein, E; Friedman, J; Gransar, H; Achenbach, S; Al-Mallah, M; Budoff, M; Cademartiri, F; Maffei, E; Callister, T; Chinnaiyan, K; Chow, B; DeLago, A; Hadamitzky, M; Hausleiter, J; Kaufmann, P; Villines, T; Kim, YJ; Leipsic, J; Feuchtner, G; Cury, R; Pontone, G; Andreini, D; Pinto Marques, H; Rubinshtein, R; Chang, HJ; Lin, F; Shaw, L; Min, J; Berman, D
    Background and aims: The Agatston coronary artery calcium score (CACS) may fail to identify small or less dense coronary calcification that can be detected on coronary CT angiography (CCTA). We investigated the prevalence and prognostic importance of subtle calcified plaques on CCTA among individuals with CACS 0. Methods: From the prospective multicenter CONFIRM registry, we evaluated patients without known CAD who underwent CAC scan and CCTA. CACS was categorized as 0, 1-10, 11-100, 101-400, and >400. Patients with CACS 0 were stratified according to the visual presence of coronary plaques on CCTA. Plaque composition was categorized as non-calcified (NCP), mixed (MP) and calcified (CP). The primary outcome was a major adverse cardiac event (MACE) which was defined as death and myocardial infarction. Results: Of 4049 patients, 1741 (43%) had a CACS 0. NCP and plaques that contained calcium (MP or CP) were detected by CCTA in 110 patients (6% of CACS 0) and 64 patients (4% of CACS 0), respectively. During a 5.6 years median follow-up (IQR 5.1-6.2 years), 413 MACE events occurred (13%). Patients with CACS 0 and MP/CP detected by CCTA had similar MACE risk compared to patients with CACS 1-10 (p = 0.868). In patients with CACS 0, after adjustment for risk factors and symptom, MP/CP was associated with an increased MACE risk compared to those with entirely normal CCTA (HR 2.39, 95% CI [1.09-5.24], p = 0.030). Conclusions: A small but non-negligible proportion of patients with CACS 0 had identifiable coronary calcification, which was associated with increased MACE risk. Modifying CAC image acquisition and/or scoring methods could improve the detection of subtle coronary calcification.
    2020Journal article Open access Show more
  • Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry
    Publication . Schulman-Marcus, J; Hartaigh, B; Gransar, H; Lin, F; Valenti, V; Cho, I; Berman, D; Callister, T; DeLago, A; Hadamitzky, M; Hausleiter, J; Al-Mallah, M; Budoff, M; Kaufmann, P; Achenbach, S; Raff, G; Chinnaiyan, K; Cademartiri, F; Maffei, E; Villines, T; Kim, Y; Leipsic, J; Feuchtner, G; Rubinshtein, R; Pontone, G; Andreini, D; Marques, H; Shaw, L; Min, J
    OBJECTIVES: The purpose of this study was to examine sex-specific associations, if any, between per-vessel coronary artery disease (CAD) extent and the risk of major adverse cardiovascular events (MACE) over a 5-year study duration. BACKGROUND: The presence and extent of CAD diagnosed by coronary computed tomography angiography (CTA) is associated with increased short-term mortality and MACE. Nevertheless, some uncertainty remains regarding the influence of sex on these findings. METHODS: 5,632 patients (mean age 60.2 ± 11.8 years, 36.5% women) from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry were followed for 5 years. Obstructive CAD was defined as ≥50% luminal stenosis in a coronary vessel. Using Cox proportional hazards models, we calculated the hazard ratio (HR) for incident MACE among women and men, defined as death or myocardial infarction. RESULTS: Obstructive CAD was more prevalent in men (42% vs. 26%; p < 0.001), whereas women were more likely to have normal coronary arteries (43% vs. 27%; p < 0.001). There were a total of 798 incident MACE events. After adjustment, there was a strong association between increased MACE risk and nonobstructive CAD (HR: 2.16 for women, 2.56 for men; p < 0.001 for both), obstructive 1-vessel CAD (HR: 3.69 and 2.66; p < 0.001), 2-vessel CAD (HR: 3.92 and 3.55; p < 0.001), and 3-vessel/left main CAD (HR: 5.94 and 4.44; p < 0.001). Further exploratory analyses of atherosclerotic burden did not identify sex-specific patterns predictive of MACE. CONCLUSIONS: In a large prospective coronary CTA cohort followed long-term, we did not observe an interaction of sex for the association between MACE risk and increased per-vessel extent of obstructive CAD. These findings highlight the persistent prognostic significance of anatomic CAD subsets as detected by coronary CTA for the risk of MACE in both women and men.
    2016-04Journal article Open access Show more