TY - JOUR
T1 - Cardiovascular risk and outcomes in symptomatic patients with suspected coronary artery disease and non coronary vascular disease
T2 - A report from the PROMISE trial
AU - Vemulapalli, Sreekanth
AU - Stebbins, Amanda
AU - Jones, W. Schuyler
AU - Gutierrez, J. Antonio
AU - Patel, Manesh R.
AU - Dolor, Rowena J.
AU - Pellikka, Patricia A.
AU - Alhanti, Brooke
AU - Hoffmann, Udo
AU - Douglas, Pamela S.
N1 - Funding Information:
This project was supported by grants R01HL098237, R01HL098236, R01HL98305, and R01HL098235 from the National Heart, Lung, and Blood Institute (NHLBI). The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. This paper does not necessarily represent the official views of NHLBI.
Funding Information:
This project was supported by grants R01HL098237, R01HL098236, R01HL98305, and R01HL098235 from the National Heart, Lung, and Blood Institute (NHLBI). The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. This paper does not necessarily represent the official views of NHLBI. S.V. reports receiving research grants and contracts from the American College of Cardiology, Society of Thoracic Surgeons, Abbott Vascular, Patient Centered Outcomes Research Institute, National Institutes of Health, Food and Drug Administration (NESTcc) and Boston Scientific; Consulting fees from American College of Physicians, Boston Scientific, Janssen Pharmaceuticals, and Heart Flow. Amanda Stebbins reports no disclosures. W.S.J reports receiving research grants and contracts from Bristol-Myers Squibb, Doris Duke Charitable Foundation, Medtronic Inc, Merck, and Patient-Centered Outcomes Research Institute; Honoraria/Advisory Committees from American College of Physicians, Bayer, Bristol-Myers Squibb, and Janssen Pharmaceuticals. J.A.G reports honoraria / advisory committees from Amgen and Janssen Pharmaceuticals. M.R.P reports research grants from National Institutes of Health and advisory board / honoraria from: Bayer, Janssen Pharmaceuticals, Astra Zeneca, and HeartFlow. R.J.D reports receiving research grants and contracts from the National Institutes of Health, Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute, Epigenomics, Micromass Communications, and the European Union/Janssen Vaccines; Honoraria/Advisory Committees from Bristol-Myers Squibb, Einstein-Montefiore CTSA, and Vanderbilt University Medical Center. P.A.P reports receiving research grants and contracts from GE Healthcare, OXThera, and Lantheus, with money paid to her institution. J.A.G reports honoraria / advisory committees from Amgen and Janssen Pharmaceuticals. B.A. reports no disclosures. U.H. reports research grants/ contracts from KOWA, MedImmune, HeartFlow, Duke University (Abbott), Oregon Health and Science University (American Heart Association 13FTF16450001), and Columbia University (National Institutes of Health, 5R01-HL109711), and the NIH/NHLBI and personal fees from Abbott, Duke university (National Institutes of Health) and ReCor Medical outside the submitted work. P.S.D reports grants from HeartFlow outside the submitted work and other support from GE HealthCare.
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Background: Non-coronary vascular disease (NCVD) is associated with adverse cardiovascular events. Little is known about physician risk assessment, prevalence of coronary artery disease (CAD), cardiac catheterization, and the performance of the atherosclerotic cardiovascular disease (ASCVD) risk score in patients with NCVD. Methods: Retrospective analysis of outpatients with angina and no known CAD from the PROMISE trial. NCVD included carotid artery stenosis ≥50%, or history of stroke or peripheral artery disease. Multivariable models of physician estimates of the probability of obstructive CAD, prevalence of non-obstructive and obstructive CAD, referral to cardiac catheterization, and all-cause death/myocardial infarction/unstable angina were performed. Results: Among 10,001 patients in the PROMISE trial, 379 (3.8%) patients had NCVD. Only 8.5% of participants with NCVD were categorized as high-risk for obstructive CAD by physicians, though 15.5% (25/161) had obstructive CAD in those randomized to coronary computed tomography (CTA). NCVD was independently associated with non-obstructive (aOR = 1.58; 95% CI 1.18-2.61; P =.006) but not obstructive CAD by CTA. Adjusted referral to cardiac catheterization was similar with and without NCVD (aOR 1.04; 95% CI 0.88-1.94, P =.19). NCVD was associated with an increased risk of all-cause death/MI/UA (aOR 2.03; 95% CI 1.37-3.01, P <.001). There was no interaction between NCVD status and ASCVD risk score. Conclusions: Among patients with NCVD and angina, NCVD had increased adjusted risks of CAD and adverse outcomes which were not well described by ASCVD risk score and were underrecognized by physicians. Increased awareness and better risk stratification tools for patients with NCVD may be necessary to recognize the associated CV risk and optimize diagnostic testing and therapies.
AB - Background: Non-coronary vascular disease (NCVD) is associated with adverse cardiovascular events. Little is known about physician risk assessment, prevalence of coronary artery disease (CAD), cardiac catheterization, and the performance of the atherosclerotic cardiovascular disease (ASCVD) risk score in patients with NCVD. Methods: Retrospective analysis of outpatients with angina and no known CAD from the PROMISE trial. NCVD included carotid artery stenosis ≥50%, or history of stroke or peripheral artery disease. Multivariable models of physician estimates of the probability of obstructive CAD, prevalence of non-obstructive and obstructive CAD, referral to cardiac catheterization, and all-cause death/myocardial infarction/unstable angina were performed. Results: Among 10,001 patients in the PROMISE trial, 379 (3.8%) patients had NCVD. Only 8.5% of participants with NCVD were categorized as high-risk for obstructive CAD by physicians, though 15.5% (25/161) had obstructive CAD in those randomized to coronary computed tomography (CTA). NCVD was independently associated with non-obstructive (aOR = 1.58; 95% CI 1.18-2.61; P =.006) but not obstructive CAD by CTA. Adjusted referral to cardiac catheterization was similar with and without NCVD (aOR 1.04; 95% CI 0.88-1.94, P =.19). NCVD was associated with an increased risk of all-cause death/MI/UA (aOR 2.03; 95% CI 1.37-3.01, P <.001). There was no interaction between NCVD status and ASCVD risk score. Conclusions: Among patients with NCVD and angina, NCVD had increased adjusted risks of CAD and adverse outcomes which were not well described by ASCVD risk score and were underrecognized by physicians. Increased awareness and better risk stratification tools for patients with NCVD may be necessary to recognize the associated CV risk and optimize diagnostic testing and therapies.
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U2 - 10.1016/j.ahj.2021.07.010
DO - 10.1016/j.ahj.2021.07.010
M3 - Article
C2 - 34384742
AN - SCOPUS:85121477053
VL - 242
SP - 82
EP - 91
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -