Author + information
- Received November 1, 2016
- Revision received February 14, 2017
- Accepted February 16, 2017
- Published online December 4, 2017.
- Aukelien C. Dimitriu-Leen, MDa,
- Alexander R. van Rosendael, MDa,b,
- Jeff M. Smit, MDa,
- Tessa van Elst, BACa,
- Nan van Geloven, PhDc,
- Teemu Maaniitty, MDd,
- J. Wouter Jukema, MD, PhDa,
- Victoria Delgado, MD, PhDa,
- Arthur J.H.A. Scholte, MD, PhDa,
- Antti Saraste, MD, PhDd,
- Juhani Knuuti, MD, PhDd and
- Jeroen J. Bax, MD, PhDa,∗ ()
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bNetherlands Heart Institute, Utrecht, the Netherlands
- cThe Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, the Netherlands
- dTurku PET Centre, Turku, Finland
- ↵∗Address for correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Objectives The aim of the present study was to evaluate, in low-to-intermediate pre-test probability patients who were referred for coronary computed tomography angiography (CTA) and did not show obstructive coronary artery disease (CAD), whether an intramural course of a coronary artery is associated with worse outcome compared with patients without an intramural course of the coronary arteries.
Background The prognostic value of an intramural course of the coronary arteries on coronary CTA in patients without obstructive CAD is not well-known.
Methods The study population consisted of 947 patients with a low-to-intermediate pre-test probability who were referred for coronary CTA and who did not have obstructive CAD. During follow-up, the occurrence of unstable angina pectoris that required hospitalization, nonfatal myocardial infarction, and all-cause mortality was evaluated.
Results On coronary CTA, 210 patients (22%) had an intramural course of a coronary artery. The median depth of the intramural course was 1.9 mm (interquartile range: 1.4 to 2.6 mm). In 84 patients (40%), the depth of the intramural course was considered deep (>2 mm surrounded by myocardium). During a median follow-up of 4.9 years (interquartile range: 3.2 to 6.9 years), a total of 43 events occurred: hospitalization due to unstable angina pectoris in 13 patients (1.4%); 7 patients (0.7%) had a nonfatal myocardial infarction; and 23 patients died (2.4%). The 6-year cumulative event rate of unstable angina pectoris requiring hospitalization (0.0% vs. 1.1%), nonfatal myocardial infarction (0.5% vs. 0.4%), all-cause mortality (1.9% vs. 2.2%) as well as the combined endpoint of all 3 events (2.4% vs. 3.7%) was similar in patients with and without an intramural course of a coronary artery.
Conclusions In patients without obstructive CAD on coronary CTA, the presence of an intramural course of a coronary artery was not associated with worse outcome.
The Department of Cardiology of the Leiden University Medical Center received research grants from Edwards Lifesciences, Biotronik, Medtronic, and Boston Scientific. Dr. Knuuti was supported by the Academy of Finland Centre of Excellence on Cardiovascular and Metabolic Diseases, the Finnish Foundation for Cardiovascular Research, and the Turku University Hospital. Dr. Delgado has received speaking fees from Abbott Vascular. Dr. Knuuti has received speaking fees from GE Healthcare and Phillips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 1, 2016.
- Revision received February 14, 2017.
- Accepted February 16, 2017.
- 2017 American College of Cardiology Foundation