All patients included underwent review of medical records for evidence of oeCAD by two study investigators (R.H., N.M.F.), including symptom history, cardiovascular risk factors, healthcare encounters such as ambulatory clinic visits, Emergency Department visits and hospitalizations, and cardiac investigation findings such as electrocardiogram (ECG), cardiac biomarker (troponin and N-terminal pro-B-type natriuretic peptide, NTproBNP), ECG stress test, stress imaging, coronary computed tomography angiography (CCTA), invasive coronary angiography, history of acute coronary syndrome (ACS) or myocardial infarction (MI), and/or coronary artery revascularization. The clinical indication for oeCAD evaluation, in addition to the temporal relation with ATTR-CM diagnosis (occurring before, after, or simultaneous with) was also collected.
As patients with ATTR-CM often have clinical characteristics and/or non-invasive investigation result findings that resemble oeCAD (such as chest pain, chronically elevated troponin levels, and anterior Q-waves on ECG), a strict definition of oeCAD was used for this analysis. A diagnosis of CAD required ≥ 1 of the following criteria: (1) prior history of coronary artery revascularization by either percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG), (2) obstructive epicardial coronary artery stenosis of ≥ 70% by CCTA or invasive coronary angiography, or ≥ 50% of the left main coronary artery [11 (link)]. This strict criteria was selected in order to definitively confirm the presence of obstructive epicardial coronary artery disease lesions in ATTR-CM patients, and to discriminate the presence oeCAD from patients who may have microvascular coronary artery disease or findings on non-invasive evaluation (such as ECG or echocardiography) that are secondary to myocardial amyloid fibril infiltration but resemble oeCAD. Among patients with a prior history of ACS/MI, all had subsequent confirmatory invasive coronary angiography.
As patients with ATTR-CM often have clinical characteristics and/or non-invasive investigation result findings that resemble oeCAD (such as chest pain, chronically elevated troponin levels, and anterior Q-waves on ECG), a strict definition of oeCAD was used for this analysis. A diagnosis of CAD required ≥ 1 of the following criteria: (1) prior history of coronary artery revascularization by either percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG), (2) obstructive epicardial coronary artery stenosis of ≥ 70% by CCTA or invasive coronary angiography, or ≥ 50% of the left main coronary artery [11 (link)]. This strict criteria was selected in order to definitively confirm the presence of obstructive epicardial coronary artery disease lesions in ATTR-CM patients, and to discriminate the presence oeCAD from patients who may have microvascular coronary artery disease or findings on non-invasive evaluation (such as ECG or echocardiography) that are secondary to myocardial amyloid fibril infiltration but resemble oeCAD. Among patients with a prior history of ACS/MI, all had subsequent confirmatory invasive coronary angiography.
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