Non-coronary vascular disease (NCVD) is associated with adverse cardiovascular events. Little is known about physician risk assessment, prevalence of coronary artery disease (CAD), cardiac catheterization, and the performance of the atherosclerotic cardiovascular disease (ASCVD) risk score in patients with NCVD. Retrospective analysis of outpatients with angina and no known CAD from the PROMISE trial. NCVD included carotid artery stenosis ≥50%, or history of stroke or peripheral artery disease. Multivariable models of physician estimates of the probability of obstructive CAD, prevalence of non-obstructive and obstructive CAD, referral to cardiac catheterization, and all-cause death/myocardial infarction/unstable angina were performed. Among 10,001 patients in the PROMISE trial, 379 (3.8%) patients had NCVD. Only 8.5% of participants with NCVD were categorized as high-risk for obstructive CAD by physicians, though 15.5% (25/161) had obstructive CAD in those randomized to coronary computed tomography (CTA). NCVD was independently associated with non-obstructive (aOR = 1.58; 95% CI 1.18-2.61; = .006) but not obstructive CAD by CTA. Adjusted referral to cardiac catheterization was similar with and without NCVD (aOR 1.04; 95% CI 0.88-1.94, = .19). NCVD was associated with an increased risk of all-cause death/MI/UA (aOR 2.03; 95% CI 1.37-3.01, < .001). There was no interaction between NCVD status and ASCVD risk score. Among patients with NCVD and angina, NCVD had increased adjusted risks of CAD and adverse outcomes which were not well described by ASCVD risk score and were underrecognized by physicians. Increased awareness and better risk stratification tools for patients with NCVD may be necessary to recognize the associated CV risk and optimize diagnostic testing and therapies.

中文翻译：

---

有症状的疑似冠状动脉疾病和非冠状血管疾病患者的心血管风险和结果：来自 PROMISE 试验的报告

非冠状血管疾病（NCVD）与不良心血管事件相关。对于医生风险评估、冠状动脉疾病 (CAD) 患病率、心导管插入术以及 NCVD 患者的动脉粥样硬化性心血管疾病 (ASCVD) 风险评分的表现知之甚少。对 PROMISE 试验中患有心绞痛且无已知 CAD 的门诊患者进行回顾性分析。 NCVD 包括颈动脉狭窄≥50%，或有中风或外周动脉疾病史。对阻塞性 CAD 的概率、非阻塞性和阻塞性 CAD 的患病率、转诊心导管插入术以及全因死亡/心肌梗死/不稳定心绞痛进行了医生估计的多变量模型。在 PROMISE 试验的 10,001 名患者中，379 名 (3.8%) 患者患有 NCVD。只有 8.5% 的 NCVD 参与者被医生归类为阻塞性 CAD 的高风险，但在随机接受冠状动脉计算机断层扫描 (CTA) 的参与者中，15.5% (25/161) 患有阻塞性 CAD。根据 CTA 检测，NCVD 与非阻塞性 CAD 独立相关（aOR = 1.58；95% CI 1.18-2.61；= 0.006），但与阻塞性 CAD 无关。调整后的心导管检查转诊在有无 NCVD 的情况下相似（aOR 1.04；95% CI 0.88-1.94，= 0.19）。 NCVD 与全因死亡/MI/UA 风险增加相关（aOR 2.03；95% CI 1.37-3.01，< .001）。 NCVD 状态和 ASCVD 风险评分之间没有交互作用。在患有 NCVD 和心绞痛的患者中，NCVD 增加了 CAD 的调整风险和不良后果，而 ASCVD 风险评分无法很好地描述这些风险，并且医生也没有充分认识到这一点。提高 NCVD 患者的认识和更好的风险分层工具可能对于识别相关的 CV 风险并优化诊断测试和治疗是必要的。