Inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease (The Oxford Risk Factors And Non-invasive imaging study): A multicentre, longitudinal cohort study
Abstract
SUMMARY Background: Coronary computed tomography angiography (CCTA) is the first line investigation for chest pain, and it is used to guide revascularisation. However, the widespread adoption of CCTA has revealed a large group of individuals without obstructive coronary artery disease (CAD), with unclear prognosis and management. Measurement of coronary inflammation from CCTA using perivascular fat attenuation index (FAI) Score could enable cardiovascular risk prediction and guide the management of individuals without obstructive CAD. Methods: Consecutive patients undergoing clinically indicated CCTA in 8 UK hospitals (n=40,091) were followed for Major Adverse Cardiac Events (MACE; myocardial infarction, new onset heart failure, or cardiac death) for a median(IQR) of 2·7(1·4–5·3)years. The prognostic value of FAI Score in the presence and absence of obstructive CAD was evaluated in 3,393 consecutive patients from the 2 hospitals with the longest follow up [7·7(6·4–9·1)years]. An artificial intelligence-enhanced cardiac risk prediction algorithm (AI-Risk), that integrates FAI Score, coronary plaque metrics and clinical risk factors, was then evaluated in this population. Findings: Patients without obstructive CAD (n=32,533, 81·1%) accounted for 66·3% (n=2,857) of MACE and 63·7% (n=1,118) of cardiac deaths during follow up. Increased FAI Score in all the three coronary arteries had an additive impact on the risk for cardiac mortality (HR 29∙8, 95% CI 13∙9–63∙0, P<0.001) or…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 40,091 participants or records.
Read the paper
Related studies
- Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial
- Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial
- Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study
- A randomized, controlled trial of oral propranolol in infantile hemangioma
- Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study
- Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.