Risk stratification of non-obstructive coronary artery disease for guidance of preventive medical therapy

In Chang Hwang, Heesun Lee, Yeonyee E. Yoon, In Soon Choi, Hack Lyoung Kim, Hyuk Jae Chang, Ja Youn Lee, Jin A. Choi, Hyo Jeong Kim, Goo Yeong Cho, Jun Bean Park, Seung Pyo Lee, Hyung Kwan Kim, Yong Jin Kim, Dae Won Sohn

Research output: Contribution to journalArticle

Abstract

Background and aims: Given the potential benefit of medical therapy in patients with non-obstructive coronary artery disease (CAD), there is a need for risk stratification and treatment strategy for these patients. We aimed to develop a risk prediction model for non-obstructive CAD patients for risk stratification and guidance of statin and aspirin therapy. Methods: From a cohort of consecutive patients who underwent coronary computed tomography angiography (CCTA) (n = 25,087), we identified patients with non-obstructive CAD of 1–49% diameter-stenosis (n = 6243) and developed a risk prediction model for 5-year occurrence of a composite of all-cause mortality, myocardial infarction, and late coronary revascularization using a derivation cohort (n = 4391). Results: Age, sex, hypertension, diabetes, anemia, C-reactive protein, and the extent of non-obstructive CAD were incorporated in the prediction model (risk score 0-13, C-index = 0.716). Patients were categorized into 4 groups; risk score of 0–3 (low-risk), 4-6 (intermediate-risk), 7-9 (high-risk), and ≥10 (very high-risk). Patients with very high-risk demonstrated unfavorable outcome comparable to patients with obstructive CAD. The low-risk group exhibited favorable outcome similar to those with no CAD. While statin therapy was associated with better outcomes in high- or very high-risk group (hazard ratio, 0.62; 95% confidence interval, 0.39–0.96; p = 0.033), aspirin use was associated with an increased risk in low-risk group (hazard ratio, 2.57; 95% confidence interval, 1.34–4.90; p = 0.004). Conclusions: A dedicated risk scoring system for non-obstructive CAD using clinical factors and CCTA findings accurately predicted prognosis. According to our risk prediction model, statin therapy can be beneficial for high-risk patients, whereas aspirin can be harmful for low-risk patients.

Original languageEnglish
Pages (from-to)66-73
Number of pages8
JournalAtherosclerosis
Volume290
DOIs
Publication statusPublished - 2019 Nov

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Hwang, I. C., Lee, H., Yoon, Y. E., Choi, I. S., Kim, H. L., Chang, H. J., Lee, J. Y., Choi, J. A., Kim, H. J., Cho, G. Y., Park, J. B., Lee, S. P., Kim, H. K., Kim, Y. J., & Sohn, D. W. (2019). Risk stratification of non-obstructive coronary artery disease for guidance of preventive medical therapy. Atherosclerosis, 290, 66-73. https://doi.org/10.1016/j.atherosclerosis.2019.09.018