BACKGROUND Patients with obstructive coronary artery disease (CAD) are at high risk for cardiovascular disease (CVD) events. However, it remains unclear whether the high risk is due to high atherosclerotic disease burden or if presence of stenosis has independent predictive value. OBJECTIVES The purpose of this study was to evaluate if obstructive CAD provides predictive value beyond its association with total calcified atherosclerotic plaque burden as assessed by coronary artery calcium (CAC). METHODS Among 23,759 symptomatic patients from the Western Denmark Heart Registry who underwent diagnostic computed tomography angiography (CTA), we assessed the risk of major CVD (myocardial infarction, stroke, and all-cause death) stratified by CAC burden and number of vessels with obstructive disease. RESULTS During a median follow-up of 4.3 years, 1,054 patients experienced a first major CVD event. The event rate increased stepwise with both higher CAC scores and number of vessels with obstructive disease (by CAC scores: 6.2 per 1,000 person-years (PY) for CAC = 0 to 42.3 per 1,000 PY for CAC >1,000; by number of vessels with obstructive disease: 6.1 per 1,000 PY for no CAD to 34.7 per 1,000 PY for 3-vessel disease). When stratified by 5 groups of CAC scores (0, 1 to 99, 100 to 399, 400 to 1,000, and >1,000), the presence of obstructive CAD was not associated with higher risk than presence of nonobstructive CAD. CONCLUSIONS Plaque burden, not stenosis per se, is the main predictor of risk for CVD events and death. Thus, patients with a comparable calcified atherosclerosis burden generally carry a similar risk for CVD events regardless of whether they have nonobstructive or obstructive CAD.

中文翻译：

---

斑块负担与狭窄对冠状动脉粥样硬化患者缺血事件的影响

背景 患有阻塞性冠状动脉疾病 (CAD) 的患者处于心血管疾病 (CVD) 事件的高风险中。然而，尚不清楚高风险是由于高动脉粥样硬化疾病负担还是狭窄的存在是否具有独立的预测价值。目的 本研究的目的是评估阻塞性 CAD 是否提供预测价值，超出其与冠状动脉钙化 (CAC) 评估的总钙化动脉粥样硬化斑块负荷的关联。方法 在丹麦西部心脏登记处接受诊断性计算机断层扫描血管造影 (CTA) 的 23,759 名有症状患者中，我们评估了主要 CVD（心肌梗塞、中风和全因死亡）的风险，这些风险按 CAC 负担和阻塞性血管数量分层。疾病。结果 在 4.3 年的中位随访期间，1、054 名患者经历了第一次重大 CVD 事件。事件发生率随着更高的 CAC 评分和阻塞性疾病的血管数量而逐步增加（根据 CAC 评分：CAC 的每 1,000 人年 (PY) 6.2 = CAC > 1,000 的每 1,000 人年 (PY) = 0 至 42.3；根据患有阻塞性疾病的血管数量）阻塞性疾病：无 CAD 每 1,000 PY 6.1 至 3 支血管疾病每 1,000 PY 34.7）。当按 5 组 CAC 评分（0、1 至 99、100 至 399、400 至 1,000 和 >1,000）进行分层时，阻塞性 CAD 的存在与非阻塞性 CAD 的风险无关。结论 斑块负荷，而不是狭窄本身，是 CVD 事件和死亡风险的主要预测因素。因此，