Prognostic Value of Atherosclerosis Progression for Prediction of Cardiovascular Events in Patients with Nonobstructive Coronary Artery Disease

Rationale and Objectives: Coronary CT angiography (CCTA) is a noninvasive reliable cardiovascular imaging technology to assess coronary atherosclerosis progression. However, there is limited data available to investigate the relationship between the atherosclerosis progression and cardiovascular events in patients with nonobstructive coronary artery disease (CAD). Materials and Methods: A total of 757 patients (53.4 +/- 9.5 years, 61.2% male) with nonobstructive CAD (1%-49% diameter stenosis) who underwent baseline and follow-up CCTA were retrospectively included in this study. Coronary atherosclerosis and its changing were analyzed by these following semi-quantitative scores: (1) obstructive plaque scores (three-vessel plaque score and severe proximal plaque score); (2) scores exhibiting plaque distribution and extent (segment stenosis score and segment involvement score); (3) coronary artery calcium score. The end points of this study were the major adverse cardiac events (MACE), which included cardiac death, coronary revascularization, nonfatal myocardial infarction and hospitalization due to unstable angina. Results: The average time between scans was 2.0 years. After their second scan, 82 (10.8%) patients experienced MACE during 4.9 +/- 1.0 years follow-up. Combined baseline and follow-up CCTA together, we found that the progression of coronary atherosclerosis was significantly higher in patients with MACE than those without (all p < 0.05). Diabetes mellitus (hazard ratio [HR] = 3.17, p < 0.001), dyslipidemia (HR = 1.69, p = 0.046), and family history of CAD (HR = 1.79, p = 0.005) were independently associated with MACE. Three vessel plaque progression (HR = 2.37, p = 0.026) and severe proximal plaque progression (HR = 3.65, p = 0.003) were strong predictors of MACE. Conclusion: Coronary atherosclerosis progression had a predictive value of MACE in patients with nonobstructive CAD.