Evidence map›Paper›PMID 41620307›Full record

ArticleJournal of cardiovascular computed tomography

Disproportionate atherosclerotic burden in the left anterior descending coronary artery in participants without standard modifiable cardiovascular risk factors: The multi-ethnic study of atherosclerosis (MESA).

Michael P Gray, Kristy P Robledo, Anthony C Keech, Stephen T Vernon, Matthew J Budoff, Gemma A Figtree

Abstract readMulticenter StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cardiovascular computed tomography. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Michael P GrayFaculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
Kristy P RobledoNHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
Anthony C KeechNHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Stephen T VernonFaculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
Matthew J BudoffHarbor-UCLA Medical Center, Lundquist Institute, Torrance, Calif., USA.
Gemma A FigtreeFaculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: Gemma.figtree@sydney.edu.au.

Funding

Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Clinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2M
SUBCLINICAL CARDIOVASCULAR DISEASE STUDYN01HC095166 · HC · UNIVERSITY OF VERMONT &ST AGRIC COLLEGE · PI TRACY, RUSSELL P · 1999 to 2001
$758k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-FIELD CENTERN01HC095162 · HC · JOHNS HOPKINS UNIVERSITY · PI SZKLO, MOYSES A · 1999 to 2000
$694k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--FIELD CENTERN01HC095161 · HC · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI SHEA, STEVEN · 1999 to 2001
$642k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--FIELD CENTERN01HC095165 · HC · WAKE FOREST UNIVERSITY · PI BURKE, GREGORY L · 1999 to 2001
$616k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--FIELD CENTERN01HC095160 · HC · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SAAD, MOHAMMED F · 1999 to 2001
$592k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-FIELD CENTERN01HC095164 · HC · NORTHWESTERN UNIVERSITY · PI LIU, KIANG JOHN · 1999 to 2001
$511k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--FIELD CENTERN01HC095163 · HC · UNIVERSITY OF MINNESOTA TWIN CITIES · PI FOLSOM, AARON R · 1999 to 2001
$443k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDYN01HC095168 · HC · JOHNS HOPKINS UNIVERSITY · PI BLUEMKE, DAVID A. · 1999 to 2000
$375k
SUBCLINICAL CARDIOVASCULAR DISEASE COORDINATING CENTER-N01HC95159-268095159N01HC095159 · HC · UNIVERSITY OF WASHINGTON · PI KRONMAL, RICHARD A · 1999 to 2006
$304k
NCATS NIH HHS UL1 TR000040NCATS NIH HHS UL1 TR001079NCATS NIH HHS UL1 TR001420NHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095160NHLBI NIH HHS N01 HC095161NHLBI NIH HHS N01 HC095162NHLBI NIH HHS N01 HC095163NHLBI NIH HHS N01 HC095164NHLBI NIH HHS N01 HC095165NHLBI NIH HHS N01 HC095166NHLBI NIH HHS N01 HC095167NHLBI NIH HHS N01 HC095168NHLBI NIH HHS N01 HC095169NIH HHS 75N98025D00022NIH HHS 75N98025D00025NIH HHS 75N98025D00026NIH HHS 75N98025D00027NIH HHS 75N98025D00028
6 · The paper itself

Abstract

backgroundStandard modifiable cardiovascular risk factors (SMuRF) have been identified for coronary artery disease (CAD) and targeted in primary prevention efforts, resulting in significantly improved outcomes. However, an increasing proportion of individuals present with ST elevation myocardial infarction (STEMI) in the absence of conventionally elevated levels of modifiable risk factors ("SMuRFless"), with significantly worse short-term outcomes. Culprit lesions of the left anterior descending artery (LAD) are more frequently implicated in SMuRFless STEMI patients than those with at least one risk factor. Differences in segmental-level coronary disease burden outside the acute setting in SMuRFless individuals are largely unknown.

objectivesTo characterise vessel-level coronary calcification, comparing SMuRFless to SMuRF≥1 participants.

methodsSecondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) was completed. Coronary artery calcium score (CACS) was measured at baseline and follow-up (median 6.3 years).

results6792 participants were included, with 20.6 ​% classified as SMuRFless. Among participants with detectable coronary calcification at baseline, SMuRFless participants had a significantly higher proportion of their total coronary calcium localised to the LAD, compared to SMuRF≥1 participants (74.2 ​% vs. 58.9 ​%, p ​< ​0.0001). This difference was most pronounced in individuals with higher baseline total CACS (CACS 100-400 Agatston units [AU] and CACS 401+), but attenuated after multivariable adjustment and was not statistically significant in best-subsets modelling. LAD CACS progressed in both groups during follow-up; however, annualised progression rates were similar between SMuRFless and SMuRF≥1 participants after adjustment for total coronary calcium progression and follow-up duration.

conclusionSMuRFless MESA participants had a higher unadjusted proportion of coronary calcification in the LAD compared SMuRF≥1 participants; however, this associated attenuated after multivariable adjustment. Further research is warranted to better understand the development of atherosclerotic CAD in SMuRFless individuals, and biological relevance and potentially different susceptibility at the epicardial segment level.

Indexed as

Coronary Artery DiseaseCoronary VesselsPlaque, AtheroscleroticVascular CalcificationAgedAged, 80 and overComputed Tomography AngiographyCoronary AngiographyFemaleHeart Disease Risk FactorsHumansMaleMiddle AgedPredictive Value of TestsPrognosisRisk AssessmentAtherosclerotic cardiovascular diseaseCoronary artery calcificationCoronary heart diseaseStandard modifiable cardiovascular risk factor (SMuRF)

Identifiers

PMID41620307
PMCPMC13157333

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.