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Obstructive epicardial coronary artery disease is prevalent and frequently diagnosed in patients with transthyretin amyloidosis cardiomyopathy.

Patients diagnosed with transthyretin amyloidosis cardiomyopathy (ATTR-CM) are usually older, and such patients can be at risk for developing obstructive epicardial coronary artery disease (oeCAD). The current study aimed to describe the clinical significance, incidence, and prevalence of oeCAD in ATTR-CM. The study concluded that oeCAD is prevalent among patients with ATTR-CM; however, the identification of oeCAD is frequently made at the time of diagnosis of ATTR-CM, and the clinical characteristics are similar to those found in non-oeCAD patients. These study findings are published in the journal BMC Cardiovascular Disorders.

Unveiling the Silent Link: 25% of ATTR-CM Patients Also Diagnosed With oeCAD

According to the study findings, one-quarter of the patients with ATTR-CM had a concurrent diagnosis of oeCAD. Most of these patients (51%) were diagnosed with oeCAD 21 months to 38 years before the diagnosis of ATTR-CM. Fifty-four percent of the ATTR-CM patients underwent investigations for oeCAD, whereas the remaining 46% of the ATTR-CM patients were not subjected to any investigations for oeCAD.

Patients Who Underwent oeCAD-Related Investigation Yielded Negative Results

Based on the clinical presentation of patients with ATTR-CM, most of these patients underwent some investigations related to oeCAD. The majority of these investigations yielded negative results. The majority of the patients with ATTR-CM and oeCAD did not demonstrate the clinical manifestation of oeCAD during the time of diagnosis and follow-up of ATTR-CM.  

The study findings also suggested that the diagnosis of oeCAD in the ATTR-CM patients was not associated with any adverse outcomes.

Outcomes of ATTR-CM Patients With and Without oeCAD

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At the median follow-up of ATTR-CM patients at 27 months, 37 had died, 5 of whom had oeCAD, and the remaining either did not have oeCAD or were not investigated for oeCAD. Based on Cox proportional hazards modeling, oeCAD and mortality were not significantly associated. In the follow-up period, 56 ATTR-CM patients were hospitalized, including 10 patients with concurrent oeCAD, 13 patients without oeCAD, and 33 patients without oeCAD-related investigation.  

The study findings indicate that oeCAD is prevalent in ATTR-CM patients and may precede the diagnosis of this disease. The characteristics of ATTR-CM patients with oeCAD are similar to those without oeCAD.


Hassan, R., Miller, R. J. H., Howlett, J. G., White, J. A., & Fine, N. M. (2023). Prevalence, incidence and clinical outcomes of epicardial coronary artery disease among transthyretin amyloidosis cardiomyopathy patients. BMC Cardiovascular Disorders, 23(1), 124. https://doi.org/10.1186/s12872-023-03140-y