Aim Obstructive coronary artery disease (CAD) in proximal coronary segments is associated with a poor prognosis. However, the relative importance of plaque location regarding the risk for major adverse cardiovascular events (MACE) in patients with non-obstructive CAD has not been well defined. Methods and results From the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter (CONFIRM) registry, 4644 patients without obstructive CAD were included in this study. The degree of stenosis was classified as 0 (no) and 1–49% (non-obstructive). Proximal involvement was defined as any plaque present in the left main or the proximal segment of the left anterior descending artery, left circumflex artery, and right coronary artery. Extensive CAD was defined as segment involvement score of >4. During a median follow-up of 5.2 years (interquartile range 4.1–6.0), 340 (7.3%) MACE occurred. Within the non-obstructive CAD group (n = 2065), proximal involvement was observed in 1767 (85.6%) cases. When compared to non-obstructive CAD patients without proximal involvement, those with proximal involvement had an increased MACE risk (log-rank P = 0.033). Multivariate Cox analysis showed when compared to patients with no CAD, proximal non-obstructive CAD was associated with increased MACE risk [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.47–2.45, P < 0.001] after adjusting for extensive CAD and conventional cardiovascular risk factors; however, non-proximal non-obstructive CAD did not increase MACE risk (HR 1.26, 95% CI 0.79–2.01, P = 0.339). Conclusions Independent of plaque extent, proximal coronary involvement was associated with increased MACE risk in patients with non-obstructive CAD. The plaque location information by coronary computed tomography angiography may provide additional risk prediction over CAD extent in patients with non-obstructive CAD.

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斑块位置在非阻塞性冠状动脉疾病中的预后意义：来自 CONFIRM 登记处

目的冠状动脉近端节段的阻塞性冠状动脉疾病（CAD）与预后不良有关。然而，斑块位置对非阻塞性 CAD 患者发生主要不良心血管事件 (MACE) 风险的相对重要性尚未明确定义。方法和结果 来自冠状动脉 CT 血管造影临床结果评估：一项国际多中心 (CONFIRM) 登记，4644 名无阻塞性 CAD 的患者被纳入本研究。狭窄程度分为 0（无）和 1-49%（非阻塞性）。近端受累定义为存在于左前降支、左回旋支和右冠状动脉的左主干或近段的任何斑块。广泛 CAD 定义为节段受累评分＞4。在 5.2 年的中位随访期间（四分位距 4.1-6.0），发生了 340 例（7.3%）MACE。在非阻塞性 CAD 组 (n = 2065) 中，1767 例 (85.6%) 病例观察到近端受累。与没有近端受累的非阻塞性 CAD 患者相比，近端受累的患者 MACE 风险增加（对数秩 P = 0.033）。多变量 Cox 分析显示，与没有 CAD 的患者相比，近端非阻塞性 CAD 与 MACE 风险增加相关[风险比 (HR) 1.90, 95% 置信区间 (CI) 1.47–2.45, P <; 0.001] 在调整广泛的 CAD 和常规心血管危险因素后；然而，非近端非阻塞性 CAD 并未增加 MACE 风险（HR 1.26, 95% CI 0.79–2.01, P = 0.339）。结论 与斑块范围无关，近端冠状动脉受累与非阻塞性 CAD 患者的 MACE 风险增加有关。冠状动脉计算机断层扫描血管造影的斑块位置信息可以为非阻塞性 CAD 患者的 CAD 范围提供额外的风险预测。