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

  • Author Footnotes
    1 These authors contributed equally to this work as co-first authors.
    In-Chang Hwang
    Footnotes
    1 These authors contributed equally to this work as co-first authors.
    Affiliations
    Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work as co-first authors.
    Heesun Lee
    Footnotes
    1 These authors contributed equally to this work as co-first authors.
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    2 These authors contributed equally to this work as co-corresponding authors.
    Yeonyee E. Yoon
    Correspondence
    Corresponding author. Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam City, Gyeonggi-do, 13620, South Korea.
    Footnotes
    2 These authors contributed equally to this work as co-corresponding authors.
    Affiliations
    Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    2 These authors contributed equally to this work as co-corresponding authors.
    In-Soon Choi
    Correspondence
    Corresponding author.
    Footnotes
    2 These authors contributed equally to this work as co-corresponding authors.
    Affiliations
    National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
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  • Hack-Lyoung Kim
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, South Korea
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  • Hyuk-Jae Chang
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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  • Ja Youn Lee
    Affiliations
    National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
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  • Jin A. Choi
    Affiliations
    National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
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  • Hyo Jeong Kim
    Affiliations
    National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
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  • Goo-Yeong Cho
    Affiliations
    Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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  • Jun-Bean Park
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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  • Seung-Pyo Lee
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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  • Hyung-Kwan Kim
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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  • Yong-Jin Kim
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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  • Dae-Won Sohn
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work as co-first authors.
    2 These authors contributed equally to this work as co-corresponding authors.

      Highlights

      • We developed a risk prediction model for patients with non-obstructive CAD by CCTA.
      • The prediction model included clinical factors and extent of non-obstructive CAD.
      • Statin therapy improved outcomes in the high-risk group by the prediction model.
      • Use of aspirin was associated with worse outcomes in the low-risk group.
      • The prediction model can guide preventive medical therapy for non-obstructive CAD.

      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.

      Graphical abstract

      Keywords

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