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. 2023 Mar 8;23(1):124.
doi: 10.1186/s12872-023-03140-y.

Prevalence, incidence and clinical outcomes of epicardial coronary artery disease among transthyretin amyloidosis cardiomyopathy patients

Rana Hassan  1 , Robert J H Miller  1 , Jonathan G Howlett  1 , James A White  1 , Nowell M Fine  2
Affiliations

Prevalence, incidence and clinical outcomes of epicardial coronary artery disease among transthyretin amyloidosis cardiomyopathy patients

Rana Hassan et al. BMC Cardiovasc Disord. .

Abstract

Background: Transthyretin amyloidosis cardiomyopathy (ATTR-CM) patients are often older and may be at risk for obstructive epicardial coronary artery disease (oeCAD). While ATTR-CM may cause small vessel coronary disease, the prevalence and clinical significance of oeCAD is not well described.

Methods and results: The prevalence and incidence of oeCAD and its association with all-cause mortality and hospitalization among 133 ATTR-CM patients with ≥ 1-year follow-up was evaluated. The mean age was 78 ± 9 years, 119 (89%) were male, 116 (87%) had wild-type and 17 (13%) had hereditary subtypes. Seventy-two (54%) patients underwent oeCAD investigations, with 30 (42%) receiving a positive diagnosis. Among patients with a positive oeCAD diagnosis, 23 (77%) were diagnosed prior to ATTR-CM diagnosis, 6 (20%) at the time of ATTR-CM diagnosis, and 1 (3%) after ATTR-CM diagnosis. Baseline characteristics between patients with and without oeCAD were similar. Among patients with oeCAD, only 2 (7%) required additional investigations, intervention or hospitalization after ATTR-CM diagnosis. After a median follow-up of 27 months there were 37 (28%) deaths in the study population, including 5 patients with oeCAD (17%). Fifty-six (42%) patients in the study population required hospitalization, including 10 patients with oeCAD (33%). There was no significant difference in the rates of death or hospitalization among ATTR-CM patients with and without oeCAD, and oeCAD was not significantly associated with either outcome by univariable regression analysis.

Conclusions: While oeCAD is prevalent in ATTR-CM patients, this diagnosis is frequently known at time of ATTR-CM diagnosis and characteristics are similar to patients without oeCAD.

Keywords: Amyloidosis; Coronary artery disease; Mortality; Prevalence; Transthyretin amyloidosis cardiomyopathy.

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Conflict of interest statement

Dr. Fine has received research support from Pfizer, Akcea/Ionis, Eidos and Alnylam and consulting honoraria from Pfizer, Akcea/Ionis and Alynylam. Dr. Miller has received research support from Pfizer and consulting honoraria from Pfizer and Alnylam. Dr White has received research support from Pfizer, Siemens Healthineers, and Circle Cardiovascular Inc., and holds shares in Cohesic Inc. The remaining authors have no relevant disclosures.

Figures

Fig. 1
Fig. 1
Study flow chart illustrating the time course of obstructive epicardial coronary artery disease (oeCAD) evaluation (EVAL) and diagnosis for transthyretin amyloidosis cardiomyopathy (ATTR-CM) patients, occurring either before, during or after ATTR-CM work-up/diagnosis (Dx). EVAL- indicates no oeCAD evaluation was performed, while EVAL + indicates an oeCAD evaluation was performed. CAD- indicates that a diagnosis of oeCAD was excluded after evaluation, while CAD + indicates an oeCAD diagnosis was confirmed (by invasive coronary angiography in all patients)
Fig. 2
Fig. 2
Prevalence of obstructive epicardial coronary artery disease (oeCAD) among transthyretin amyloidosis cardiomyopathy (ATTR-CM) patients, indicating the timing of oeCAD diagnosis as occurring either before, during or after their ATTR-CM work-up/diagnosis
Fig. 3
Fig. 3
Comparison of the prevalence of obstructive epicardial coronary artery disease (oeCAD) among subgroups of transthyretin amyloidosis cardiomyopathy (ATTR-CM) patients. Red bars indicate ATTR-CM patients with confirmed oeCAD and blue bars indicate the remainder of the cohort. A New York Heart Association (NYHA) functional class, B ATTR subtype, wild-type (wtATTR) or hereditary (hATTR), C left ventricular ejection fraction (LVEF), and D use of disease modifying ATTR therapy
See this image and copyright information in PMC

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Supplementary concepts