Clinical cardiology 2018 03 09() doi 10.1002/clc.22940
To assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA).
4,215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis) were identified. CAD severity was categorized as non-obstructive (1%-49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as: asymptomatic, non-anginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina and late revascularization, according to symptom typicality. RESULTS
Mean age was 57.0±12.0 years (54.9% male). During a median follow-up of 5.3 years (IQR, 4.6-5.9 years), MACE was reported in 312 (7.4%) patients. Among patients with non-obstructive CAD, there was an association between symptom typicality and MACE (p for interaction =.05), driven by increased risk of MACE among those with typical angina and non-obstructive CAD (HR 1.62, 95% CI: 1.06-2.48, P =.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (HR 0.73, 95% CI: 0.34-1.57, P =.08).
In the CONFIRM registry, patients who presented with concomitant typical angina and non-obstructive CAD had a higher rate of MACE than asymptomatic patients with non-obstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.