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
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 26, 2019
Accepted:
September 25,
2019
Received in revised form:
September 19,
2019
Received:
February 7,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
