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- Title
Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort: A Prospective Observational Cohort Study.
- Authors
Fuchs, Andreas; Kühl, Jørgen Tobias; Sigvardsen, Per Ejlstrup; Afzal, Shoaib; Knudsen, Andreas Dehlbæk; Møller, Mathias Bech; de Knegt, Martina Chantal; Sørgaard, Mathias Holm; Nordestgaard, Børge Grønne; Køber, Lars Valeur; Kofoed, Klaus Fuglsang
- Abstract
The association between image-detected, subclinical coronary atherosclerosis and outcomes is unclear. In this population-based study, compared with persons with no image-detected obstruction, persons with both obstructive and nonobstructive yet extensive disease had significantly higher relative risk for myocardial infarction and death despite the absence of symptoms. Visual Abstract. Subclinical Coronary Atherosclerosis and Myocardial Infarction.: The association between image-detected, subclinical coronary atherosclerosis and outcomes is unclear. In this population-based study, compared with persons with no image-detected obstruction, the relative risk for myocardial infarction and death in persons with both obstructive and nonobstructive yet extensive disease was significantly increased despite the absence of symptoms. These findings have important implications for screening of coronary artery disease. Background: Coronary atherosclerosis may develop at an early age and remain latent for many years. Objective: To define characteristics of subclinical coronary atherosclerosis associated with the development of myocardial infarction. Design: Prospective observational cohort study. Setting: Copenhagen General Population Study, Denmark. Participants: 9533 asymptomatic persons aged 40 years or older without known ischemic heart disease. Measurements: Subclinical coronary atherosclerosis was assessed with coronary computed tomography angiography conducted blinded to treatment and outcomes. Coronary atherosclerosis was characterized according to luminal obstruction (nonobstructive or obstructive [≥50% luminal stenosis]) and extent (nonextensive or extensive [one third or more of the coronary tree]). The primary outcome was myocardial infarction, and the secondary outcome was a composite of death or myocardial infarction. Results: A total of 5114 (54%) persons had no subclinical coronary atherosclerosis, 3483 (36%) had nonobstructive disease, and 936 (10%) had obstructive disease. Within a median follow-up of 3.5 years (range, 0.1 to 8.9 years), 193 persons died and 71 had myocardial infarction. The risk for myocardial infarction was increased in persons with obstructive (adjusted relative risk, 9.19 [95% CI, 4.49 to 18.11]) and extensive (7.65 [CI, 3.53 to 16.57]) disease. The highest risk for myocardial infarction was noted in persons with obstructive-extensive subclinical coronary atherosclerosis (adjusted relative risk, 12.48 [CI, 5.50 to 28.12]) or obstructive-nonextensive (adjusted relative risk, 8.28 [CI, 3.75 to 18.32]). The risk for the composite end point of death or myocardial infarction was increased in persons with extensive disease, regardless of degree of obstruction—for example, nonobstructive-extensive (adjusted relative risk, 2.70 [CI, 1.72 to 4.25]) and obstructive-extensive (adjusted relative risk, 3.15 [CI, 2.05 to 4.83]). Limitation: Mostly White persons were studied. Conclusion: In asymptomatic persons, subclinical, obstructive coronary atherosclerosis is associated with a more than 8-fold elevated risk for myocardial infarction. Primary Funding Source: AP Møller og Hustru Chastine Mc-Kinney Møllers Fond.
- Subjects
DENMARK; CORONARY artery disease; CORONARY disease; MYOCARDIAL infarction; MYOCARDIAL ischemia; COHORT analysis; ASYMPTOMATIC patients
- Publication
Annals of Internal Medicine, 2023, Vol 176, Issue 4, p433
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/M22-3027