ArticleEuropean heart journal. Cardiovascular Imaging2020
Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry.
Article in European heart journal. Cardiovascular Imaging, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Understanding Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): a comprehensive meta-analysis of clinical characteristics, management, and prognosis compared to MI with the Obstructive Coronary Artery (MIOCA).BMC cardiovascular disorders · 2025Pooled it
- Atherosclerosis quantification and cardiovascular risk: the ISCHEMIA trial.European heart journal · 2024Trial
- Advanced quantitative CT for coronary artery disease: integrating stenosis quantification, plaque quantification, and fractional flow reserve-CT.The British journal of radiology · 2026Review
- Multiparametric Coronary CT Angiography-Derived Imaging Biomarkers for Risk Stratification in Nonobstructive Coronary Artery Disease: Incremental Prognostic Value in Patients with Diabetes.Tomography (Ann Arbor, Mich.) · 2026Article
- Biological Cardiovascular Age Derived from Coronary CTA Reports Using a Large Language Model: A Novel Predictor of Major Adverse Cardiovascular Events?Diagnostics (Basel, Switzerland) · 2026Article
- A Pathophysiology-Oriented Imaging Phenotype Framework for Nonobstructive Coronary Artery Disease.Journal of cardiovascular development and disease · 2026Article
- CT-derived fractional flow reserve combined with atherosclerotic extent to determine long-term outcomes in diabetic patients with coronary artery disease.Journal of geriatric cardiology : JGC · 2026Article
- Degree of hypertension and subclinical coronary atherosclerosis in asymptomatic individuals without cardiovascular disease.PloS one · 2026Article
- Efficacy and safety of Shenqi Yangxin formula in patients with stable coronary artery disease based on CCTA: rationale, design, and study protocol for a randomized, double-blind, placebo-controlled study.Frontiers in cardiovascular medicine · 2026Article
- Coronary computed tomography angiography plaque and flow patterns in acute coronary syndrome lesions.iScience · 2025Article
- Long-term prognostic value of the CT-derived fractional flow reserve combined with atherosclerotic burden in patients with non-obstructive coronary artery disease.European radiology · 2025Article
- Long-term prognostic value of coronary atherosclerosis progression in patients with and without diabetes mellitus.Quantitative imaging in medicine and surgery · 2025Article
- Detection of subclinical atherosclerosis by image-based deep learning on chest X-ray.European heart journal. Digital health · 2025Article
- Risk stratification study of non-calcified coronary plaques based on CT pericoronary adipose tissue measurement.The international journal of cardiovascular imaging · 2025Article
- AI-assisted CCTA: supporting diagnosis across the CAD spectrum.The international journal of cardiovascular imaging · 2025Article
- Comparing predictive risk to actual presence of coronary atherosclerosis on coronary computed tomography angiography.American heart journal plus : cardiology research and practice · 2025Article
- Association of the triglyceride glucose index with myocardial ischemia in patients with minimal to moderate coronary artery disease.Scientific reports · 2024Article
- Added prognostic value of fat attenuation index and CT-derived fractional flow reserve over plaque burden in suspected CAD patients without standard modifiable risk factors.African health sciences · 2024Article
- Cardiovascular risk and subclinical atherosclerosis in first-degree relatives of patients with premature cardiovascular disease.American journal of preventive cardiology · 2024Article
- Triglyceride-glucose index is associated with myocardial ischemia and poor prognosis in patients with ischemia and no obstructive coronary artery disease.Cardiovascular diabetology · 2024Article
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Abstract
aimsIn patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. METHODS AND
resultsPatients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3-4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3-2.2) and 1.4 (95% CI 1.1-1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004).
conclusionAmong patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.
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