A function-dominant CCTA phenotype in nonobstructive coronary artery disease was associated with the highest risk of major adverse cardiovascular events (HR 4.054; 95% CI 1.984–8.281; p < 0.001).
Cohort (n=485)
Does a CCTA-derived imaging phenotype framework predict major adverse cardiovascular events in patients with nonobstructive coronary artery disease?
A CCTA-derived imaging phenotype framework categorizing NOCAD into functional, structural, and inflammatory dominance reveals a graded prognostic risk for MACE, with functional dominance conferring the highest risk.
Effect estimate: HR 4.054 (95% CI 1.984-8.281)
p-value: p=< 0.001
Nonobstructive coronary artery disease (NOCAD) is increasingly recognized as a heterogeneous condition characterized by diverse pathophysiological mechanisms despite the absence of flow-limiting stenosis. We sought to establish a rule-based dominant imaging phenotype framework integrating functional, structural, and inflammatory dimensions derived from multiparametric coronary computed tomography angiography (CCTA). In this retrospective cohort of 485 patients with NOCAD, CT-derived fractional flow reserve (CT-FFR), quantitative plaque burden and high-risk plaque features, and perivascular fat attenuation index (FAI) were assessed. Using predefined percentile thresholds and hierarchical rules, patients were categorized into function-, structure-, inflammation-dominant, or low-risk phenotypes. During a median follow-up of 36 months, 56 patients (11.5%) experienced major adverse cardiovascular events (MACE). After multivariable adjustment, function dominance was associated with the highest risk (hazard ratio HR 4.054, 95% confidence interval CI 1.984–8.281; p < 0.001), followed by structure dominance (HR 3.129, 95% CI 1.410–6.944; p = 0.005), whereas isolated inflammation dominance did not show a statistically significant independent association with events, with wide confidence intervals indicating limited precision. These findings suggest a graded pattern of prognostic associations across functional and structural abnormalities in NOCAD and support a phenotype-oriented interpretation of CCTA metrics reflecting distinct biological axes of coronary pathology.
Du et al. (Sat,) conducted a cohort in Nonobstructive coronary artery disease (NOCAD) (n=485). Function-dominant CCTA phenotype vs. Low-risk phenotype was evaluated on Major adverse cardiovascular events (MACE) (HR 4.054, 95% CI 1.984-8.281, p=< 0.001). A function-dominant CCTA phenotype in nonobstructive coronary artery disease was associated with the highest risk of major adverse cardiovascular events (HR 4.054; 95% CI 1.984–8.281; p < 0.001).