Key result
Dyspnoea was associated with a 26% increased risk of major adverse cardiovascular events (HR 1.26) after adjusting for clinical predictors and coronary artery disease severity, with the excess risk concentrated in patients with non-obstructive disease.
Why the study?
The relationship between dyspnoea, coronary artery disease, and major cardiovascular events is poorly understood.
Does the presence of dyspnoea predict severe obstructive CAD and MACE in patients with suspected CAD?
Cohort (n=4,425)
Yes
Does the presence of dyspnoea predict severe obstructive CAD and MACE in patients with suspected CAD?
Hazard Ratio: 1.26 (95% CI 1.02–1.55)
p-value: p=0.029
In patients with suspected CAD, dyspnoea is independently associated with severe obstructive CAD on CCTA and provides incremental prognostic value for MACE in those with non-obstructive CAD.
Dyspnoea may refine MACE risk stratification in non-obstructive CAD; observational data leave clinical adoption and management implications open.
AIMS: The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. METHODS AND RESULTS: From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. CONCLUSION: In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.
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Rosendael et al. (2020) conducted a cohort in Suspected coronary artery disease (n=4,425). Dyspnoea vs. Absence of dyspnoea was evaluated on Major adverse cardiovascular events (composite of all-cause death and non-fatal myocardial infarction) (HR 1.26, 95% CI 1.02-1.55, p=0.029). Dyspnoea was associated with a 26% increased risk of major adverse cardiovascular events (HR 1.26) after adjusting for clinical predictors and coronary artery disease severity, with the excess risk concentrated in patients with non-obstructive disease.
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