Table 4.
Clinical and CTA Univariable Outcome Predictors
| Variable | Coronary Heart Disease Eventa | Cardiovascular Death or Myocardial Infarction | Noncoronary Vascular Eventb | Macrovascular‐Related Eventc | Microvascular‐Related Eventd | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| HR (95% CI) | P Value | HR (95% CI) | P Value | HR (95% CI) | P Value | HR (95% CI) | P Value | HR (95% CI) | P Value | |
| Clinical variables at study entry | ||||||||||
| Age (per yr) | 1.1 (0.99–1.11) | 0.10 | 1.0 (0.95–1.1) | 0.41 | 1.04 (1.0–1.08) | 0.063 | 1.06 (1.01–1.1) | 0.018 | 1.0 (0.98–1.1) | 0.31 |
| Male sex | 1.6 (0.87–3.0) | 0.13 | 1.6 (0.64–3.8) | 0.33 | 1.48 (0.98–2.2) | 0.06 | 1.9 (1.2–3.2) | 0.009 | 0.92 (0.55–1.5) | 0.74 |
| Duration of DM (per yr) | 1.1 (1.01–1.08) | 0.012 | 1.0 (0.98–1.1) | 0.29 | 1.06 (1.04–1.08) | <0.001 | 1.04 (1.01–1.07) | 0.009 | 1.07 (1.04–1.1) | <0.001 |
| Insulin treated | 1.3 (0.66–2.6) | 0.446 | 1.2 (0.43–3.2) | 0.76 | 2.16 (1.4–3.3) | <0.001 | 1.3 (0.76–2.2) | 0.34 | 2.8 (1.7–4.7) | <0.001 |
| Current smoking | 1.2 (0.55–2.8) | 0.59 | 2.0 (0.74–5.6) | 0.17 | 1.25 (0.73–2.1) | 0.41 | 1.4 (0.73–2.5) | 0.34 | 0.80 (0.36–1.8) | 0.59 |
| Any smoking | 1.7 (0.91–3.1) | 0.099 | 1.6 (0.66–3.9) | 0.30 | 1.0 (0.69–1.5) | 0.88 | 1.4 (0.90–2.3) | 0.13 | 0.79 (0.47–1.3) | 0.38 |
| Pack‐yrs (per pack‐yr) | 1.00 (0.99–1.01) | 0.70 | 1.0 (0.98–1.0) | 0.90 | 1.0 (0.99–1.0) | 0.92 | 1.0 (0.99–1.01) | 0.42 | 1.1 (0.66–2.0) | 0.63 |
| Hypertension | 0.76 (0.40–1.4) | 0.38 | 1.1 (0.44–3.0) | 0.78 | 1.05 (0.68–1.6) | 0.83 | 0.87 (0.53–1.4) | 0.59 | 1.2 (0.66–2.0) | 0.63 |
| Family history of CAD | 0.75 (0.35–1.6) | 0.47 | 1.4 (0.52–3.5) | 0.53 | 0.56 (0.32–0.97) | 0.04 | 0.75 (0.41–1.4) | 0.36 | 0.41 (0.19–0.91) | 0.027 |
| Prior CVA/TIA | 2.1 (0.83–5.4) | 0.12 | 2.9 (0.85–9.9) | 0.089 | 1.87 (0.97–3.6) | 0.06 | 2.9 (1.5–5.7) | 0.002 | 1.4 (0.58–3.6) | 0.44 |
| Carotid stenosis | 3.1 (1.1–8.6) | 0.033 | 3.3 (0.77–14.2) | 0.11 | 1.6 (0.63–3.8) | 0.33 | 2.4 (0.95–5.9) | 0.064 | 2.1 (0.78–5.9) | 0.14 |
| Retinopathy | 1.3 (0.59–2.8) | 0.52 | 1.8 (0.64–4.9) | 0.27 | 4.0 (2.7–6.1) | <0.001 | 1.7 (0.96–3.0) | 0.068 | 6.0 (3.6–9.9) | <0.001 |
| HbA1c (%) | 1.2 (1.0–1.4) | 0.028 | 1.2 (0.92–1.5) | 0.21 | 1.3 (1.2–1.5) | <0.001 | 1.2 (1.01–1.3) | 0.035 | 1.4 (1.3–1.6) | <0.001 |
| Creatinine clearance (per mL/min) | 0.99 (0.98–1.00) | 0.16 | 1.0 (0.98–1.0) | 0.95 | 1.0 (0.99–1.0) | 0.49 | 0.99 (0.98–1.0) | 0.094 | 1.0 (0.99–1.01) | 0.81 |
| Total cholesterol (per mmol/L) | 1.4 (1.0–1.8) | 0.042 | 0.83 (0.50–1.4) | 0.46 | 1.0 (0.84–1.3) | 0.75 | 1.1 (0.83–1.4) | 0.63 | 1.2 (0.97–1.6) | 0.091 |
| HDL–cholesterol (per mmol/L) | 0.34 (0.11–1.1) | 0.073 | 0.29 (0.05–1.6) | 0.15 | 0.75 0.48–1.7) | 0.75 | 0.44 (0.18–1.1) | 0.065 | 0.85 (0.37–1.9) | 0.69 |
| Cholesterol/HDL‐C ratio (per unit) | 1.3 (1.1–1.6) | <0.001 | 1.1 (0.78–1.5) | 0.62 | 1.1 (0.91–1.2) | 0.48 | 1.2 (1.04–1.4) | 0.017 | 1.18 (1.0–1.4) | 0.044 |
| Non‐HDL cholesterol (per mmol/L) | 1.5 (1.1–1.9) | 0.008 | 0.94 (0.57–1.5) | 0.80 | 1.0 (0.85–1.3) | 0.67 | 1.2 (0.90–1.5) | 0.26 | 1.3 (0.99–1.6) | 0.063 |
| Albuminuria (per quartile) | 1.0 (0.79–1.3) | 0.85 | 1.4 (0.94–2.1) | 0.096 | 1.2 (0.99–1.4) | 0.06 | 1.0 (0.85–1.3) | 0.70 | 1.4 (1.1–1.7) | 0.009 |
| C‐reactive protein (per quartile) | 1.1 (0.86–1.5) | 0.38 | 1.5 (0.99–2.2) | 0.057 | 1.1 (0.89–1.3) | 0.52 | 1.2 (0.95–1.5) | 0.14 | 1.1 (0.85–1.3) | 0.57 |
| Framingham CHD risk score (per 10% 10‐yr risk) | 1.4 (1.2–1.7) | 0.001 | 1.4 (1.0–1.8) | 0.052 | 1.2 (1.04–1.4) | 0.02 | 1.4 (1.2–1.6) | <0.001 | 1.2 (1.01–1.5) | 0.039 |
| UKPDS CHD risk score (per 10% 10‐y risk) | 1.4 (1.3–1.6) | <0.001 | 1.2 (0.93–1.5) | 0.13 | 1.3 (1.2–1.4) | <0.001 | 1.4 (1.3–1.6) | <0.001 | 1.4 (1.2–1.5) | <0.001 |
| Statin therapy | 1.5 (0.73–3.2) | 0.26 | 1.3 (0.47–3.5) | 0.63 | 1.1 (0.73–1.8) | 0.552 | 1.7 (0.92–3.0) | 0.096 | 1.1 (0.60–1.9) | 0.84 |
| Maximal treadmill stress (per MET achieved)e | 0.84 (0.72–0.97) | 0.017 | 0.87 (0.70–1.1) | 0.22 | 0.86 (0.79–0.94) | 0.001 | 0.87 (0.78–0.97) | 0.011 | 0.86 (0.78–0.96) | 0.008 |
| CTA variables | ||||||||||
| CAC score (per quartile) | 2.3 (1.6–3.3) | <0.001 | 2.1 (1.3–2.4) | 0.002 | 1.4 (1.1–1.6) | 0.001 | 2.0 (1.6–2.6) | <0.001 | 1.1 (0.91–1.4) | 0.24 |
| Coronary arteries with plaque (0–3) | 4.0 (2.2–7.2) | <0.001 | 3.1 (1.5–6.2) | 0.002 | 1.4 (1.2–1.8) | <0.001 | 2.7 (1.9–3.7) | <0.001 | 1.2 (0.95–1.5) | 0.12 |
| Nonobstructive plaque only (vs no plaque) (N=434) | 11 vs 0 eventsf | 0.039f | 9 vs 0 eventsf | 0.063f | 1.9 (0.96–3.8) | 0.068 | 11.2 (1.5–82.8) | 0.018 | 1.3 (0.59–2.9) | 0.50 |
| No plaque | 0 events | 0 events | ||||||||
| 1 vessel nonobstructive plaque | 0 events | 0 events | ||||||||
| 2 vessel nonobst. plaque (vs none) | 6 vs 0 events | 0.009 | 4 vs 0 events | 0.044f | ||||||
| 3 vessel nonobst. plaque (vs 1–2 v) | 3.2 (0.97–10.4) | 0.057 | 3.0 (0.79–11.0) | 0.11 | 1.1 (1.9–3.4) | 0.033 | 2.4 (1.1–5.2) | 0.034 | 1.5 (0.68–3.2) | 0.33 |
| LMCA nonobst. plaque (with no stenosis at any site) | 3.4 (1.0–11.2) | 0.042 | 3.5 (0.95–13.2) | 0.060 | 1.6 (0.9–2.8) | 0.11 | 3.4 (1.6–7.4) | 0.002 | 0.82 (0.35–1.9) | 0.64 |
| LMCA nonobst. plaque (irrespective of other sites) | 3.6 (1.8–7.1) | <0.001 | 5.3 (2.0–13.7) | 0.001 | 1.8 (1.2–2.8) | 0.004 | 3.3 (1.9–5.5) | <0.001 | 1.2 (0.67–2.0) | 0.58 |
| Nonobstructive plaque in proximal segmentsg | 6.3 (0.80–49.0) | 0.08 | 5.0 (0.62–39.6) | 0.131 | 1.8 (0.97–3.3) | 0.064 | 7.7 (1.8–32.7) | 0.005 | 1.2 (0.59–2.5) | 0.58 |
| Obstructive plaque (any vs all other subjects) | 6.6 (3.3–13.1) | <0.001 | 2.8 (1.2–2.8) | 0.022 | 2.0 (1.4–3.1) | <0.001 | 3.9 (2.4–6.4) | <0.001 | 2.04 (1.2–3.4) | 0.007 |
| 1 vessel (vs no obstructive plaque) | 5.2 (2.4–11.5) | <0.001 | 2.6 (0.92–7.3) | 0.071 | 1.9 (1.2–3.1) | 0.010 | 3.4 (1.9–5.9) | <0.001 | 2.1 (1.1–3.8) | 0.017 |
| 2 vessel (vs no obstructive plaque) | 8.7 (3.8–19.6) | <0.001 | 2.5 (0.68–9.3) | 0.16 | 2.3 (1.3–4.1) | 0.004 | 4.8 (2.6–9.1) | <0.001 | 1.9 (0.89–4.2) | 0.097 |
| 3 vessel (vs no obstructive plaque) | 8.2 (2.6–25.7) | <0.001 | 4.5 (0.98–21.0) | 0.053 | 2.0 (0.80–5.0) | 0.14 | 4.5 (1.7–11.8) | 0.002 | 2.0 (0.62–6.6) | 0.25 |
| LMCA (vs all other subjects) | 3.7 (1.6–8.8) | <0.001 | 1.1 (0.14–7.9) | 0.96 | 1.4 (0.61–3.2) | 0.43 | 2.6 (1.2–5.7) | 0.017 | 2.0 (0.80–5.0) | 0.14 |
| Obstructive plaque in a proximal segment (vs all other subjects) | 6.6 (3.5–12.4) | <0.001 | 3.6 (1.5–8.7) | 0.004 | 2.0 (1.3–3.0) | 0.002 | 4.0 (2.5–6.4) | <0.001 | 1.6 (0.95–2.9) | 0.078 |
| All plaques | ||||||||||
| Plaques/subjecth (per quartile) | 2.2 (1.7–2.9) | <0.001 | 1.6 (1.0–2.6) | 0.047 | 1.22 (1.03–1.4) | 0.022 | 1.7 (1.3–2.2) | <0.001 | 0.95 (0.75–1.2) | 0.68 |
| Total plaque lengthh (per quartile) | 2.6 (1.9–3.6) | <0.001 | 1.6 (1.1–2.5) | 0.026 | 1.2 (1.05–1.5) | 0.012 | 1.7 (1.3–2.2) | <0.001 | 0.90 (0.71–1.2) | 0.42 |
| Total plaque volumeh (per quartile) | 2.3 (1.7–3.2) | <0.001 | 1.5 (0.97–2.2) | 0.067 | 1.25 (1.1–1.5) | 0.009 | 1.6 (1.2–2.0) | <0.001 | 0.96 (0.75–1.2) | 0.77 |
| Total plaque burdenh (per quartile) | 2.1 (1.5–2.9) | <0.001 | 1.5 (1.0–2.4) | 0.045 | 1.2 (0.99–1.4) | 0.067 | 1.7 (1.3–2.1) | <0.001 | 0.99 (0.78–1.3) | 0.94 |
| Characteristics of individual plaques | ||||||||||
| Maximal plaque X‐sectional areah (per quartile) | 1.7 (1.2–2.3) | 0.001 | 1.4 (0.93–2.1) | 0.11 | 1.3 (1.0–1.5) | 0.016 | 1.6 (1.3–2.0) | 0.001 | 1.1 (0.86–1.4) | 0.44 |
| Maximal plaque volumeh (per quartile) | 1.2 (0.89–1.5) | 0.27 | 0.92 (0.62–1.4) | 0.69 | 1.2 (1.0–1.5) | 0.047 | 1.2 (0.93–1.4) | 0.21 | 1.3 (1.0–1.6) | 0.050 |
| Maximal plaque burdenh (per quartile) | 2.0 (1.4–2.7) | <0.001 | 1.5 (0.97–2.2) | 0.068 | 1.5 (1.2–1.8) | <0.001 | 1.7 (1.4–2.2) | <0.001 | 1.3 (1.0–1.7) | 0.039 |
| Remodeling indexi (per quartile) | 1.6 (1.2–2.2) | 0.001 | 1.5 (1.0–2.3) | 0.045 | 1.1 (0.95–1.4) | 0.14 | 1.5 (1.2–1.8) | 0.001 | 0.99 (0.77–1.3) | 0.96 |
| True bifurcationh , i , j | 1.6 (0.84–2.9) | 0.16 | 1.5 (0.60–3.5) | 0.40 | 1.1 (0.70–1.7) | 0.71 | 1.2 (0.76–2.0) | 0.38 | 1.0 (0.59–1.8) | 0.89 |
| Plaque calcificationh | ||||||||||
| None (vs any calcified plaque)h | 1.3 (0.7–2.5) | 0.37 | 0.77 (0.28–2.1) | 0.61 | 1.3 (0.80–2.0) | 0.32 | 1.1 (0.65–1.8) | 0.73 | 1.0 (0.56–1.88) | 0.93 |
| Mild (any plaque CAC grade 1 to 2 vs all others)h | 5.4 (2.1–13.8) | <0.001 | 6.5 (1.5–28.1) | 0.012 | 1.5 (0.99–2.2) | 0.055 | 3.1 (1.7–5.8) | <0.001 | 1.0 (0.59–1.8) | 0.90 |
| Moderate/heavy (Grade 3–5 vs none)h | 0.45 (0.05–4.1) | 0.48 | 2 vs 1 event | 1.0f | 1.0 (0.5–2.0) | 0.96 | 0.55 (0.15–2.0) | 0.36 | 1.0 (0.40–2.5) | 0.99 |
| CT angiographic scores | ||||||||||
| Modified Duke CAD prognostic indexk (0–6 points) (per point) | 1.5 (1.3–1.8) | <0.001 | 1.3 (1.0–1.7) | 0.018 | 1.2 (1.1–1.4) | 0.001 | 1.4 (1.3–1.6) | <0.001 | 1.2 (1.0–1.4) | 0.054 |
| Segment stenosis scorek (per quartile) | 3.2 (2.2–4.7) | <0.001 | 2.1 (1.3–3.2) | 0.001 | 1.3 (1.1–1.6) | 0.001 | 2.0 (1.6–2.5) | <0.001 | 1.1 (0.89–1.4) | 0.35 |
| Segment involvement scorek (0–16 points) (per quartile) | 2.9 (2.0–4.2) | <0.001 | 1.3 (1.1–1.5) | <0.001 | 1.2 (1.04–1.5) | 0.017 | 2.0 (1.6–2.5) | <0.001 | 1.05 (0.84–1.3) | 0.68 |
| Gensini CAD scorek (per quartile) | 3.5 (2.3–5.5) | <0.001 | 2.3 (1.4–3.7) | 0.001 | 1.4 (1.2–1.7) | <0.001 | 2.5 (1.9–3.3) | <0.001 | 1.2 (0.93–1.5) | 0.199 |
CAC indicates coronary artery calcium; CAD, coronary artery disease; CHD, coronary heart disease; CTA, computed tomography angiography; CVA/TIA, cerebrovascular accident or transient ischemic attack; DM, diabetes mellitus; HbA1c, hemoglobin A1c; HDL‐C, high‐density lipoprotein cholesterol; LMCA, left main coronary artery; MET, metabolic equivalent; nonobst, nonobstructive; METS, Maximal treadmill stress; UKPDS, United Kingdom Prospective Diabetic Study; v, vessel.
a
Adjudicated coronary heart disease death, myocardial infarction, unstable angina, new‐onset angina.
b
Noncoronary macrovascular or microvascular event: Noncoronary vascular death, stroke, transient ischemic attack, carotid or peripheral arterial intervention or amputation, intervention for diabetic retinopathy, hospitalization for renal failure, therapy for diabetic ulcer.
c
Cardiovascular death, myocardial infarction, stroke, transient ischemic attack, carotid or peripheral vascular intervention, or amputation of limb.
d
Intervention for retinopathy, vascular event of eye, hospitalization for acute renal failure.
e
Performed in 526 patients. Exclusions mainly for logistical reasons.
f
Regression coefficients do not converge. P‐value is from Fisher's exact test from cross‐tabulation.
g
Patients with obstructive disease at other sites excluded.
h
Among individuals with plaque, N=500.
i
For plaque with maximal area remodeling in patient.
j
True bifurcation (Medina class 1,1,1) for plaque with largest cross‐sectional area.
k
Definitions as for Table 3.