CAD incidence lower in HCM vs non-HCM patients

Patients with hypertrophic cardiomyopathy (HCM) undergoing computed tomography angiography (CTA) for table chest pain enjoy a lower incidence of obstructive coronary artery disease (CAD) and show more stable coronary plaque features than those with no HCM, reveals a study.

A total of 925 patients referred for coronary CTA to assess stable chest pain were included in this retrospective cohort study. The investigators assessed CTA using the Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0 and performed quantitative plaque analysis using a dedicated software.

Of the participants, 137 (15 percent) had HCM and 788 (85 percent) non-HCM (controls). Multivariate analysis revealed the association of HCM with a 78-percent lower likelihood of obstructive CAD (≥50 percent luminal stenosis; adjusted odds ratio, 0.22, 95 percent confidence interval, 0.11‒0.43; p<0.001).

After propensity score matching (n=270), obstructive CAD remained significantly less prevalent in patients with HCM relative to matched controls (9.6 percent vs 30.4 percent; p<0.001). Similarly, high-risk plaque rate was lower among HCM than non-HCM patients (10.4 percent vs 20.0 percent; p=0.003), as was overall plaque burden (CARD-RADS ≥P3; 19.3 percent vs 34.1 percent; p=0.006).

Furthermore, the rate percutaneous coronary intervention at 1-year follow-up was lower in the HCM cohort compared with controls (3.0 percent vs 11.9 percent; p=0.005), with no significant differences in death and stroke.