TY - JOUR
T1 - Coronary artery disease grading by cardiac CT for predicting outcome in patients with stable angina
AU - Oeing, Christian U.
AU - Matheson, Matthew B.
AU - Ostovaneh, Mohammad R.
AU - Rochitte, Carlos E.
AU - Chen, Marcus Y.
AU - Pieske, Burkert
AU - Kofoed, Klaus F.
AU - Schuijf, Joanne D.
AU - Niinuma, Hiroyuki
AU - Dewey, Marc
AU - di Carli, Marcelo F.
AU - Cox, Christopher
AU - Lima, João A.C.
AU - Arbab-Zadeh, Armin
N1 - Publisher Copyright:
© 2023 Society of Cardiovascular Computed Tomography
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Background: The coronary atheroma burden drives major adverse cardiovascular events (MACE) in patients with suspected coronary heart disease (CHD). However, a consensus on how to grade disease burden for effective risk stratification is lacking. The purpose of this study was to compare the effectiveness of common CHD grading tools to risk stratify symptomatic patients. Methods: We analyzed the 5-year outcome of 381 prospectively enrolled patients in the CORE320 international, multicenter study using baseline clinical and cardiac computer-tomography (CT) imaging characteristics, including coronary artery calcium score (CACS), percent atheroma volume, “high-risk” plaque, disease severity grading using the CAD-RADS, and two simplified CAD staging systems. We applied Cox proportional hazard models and area under the curve (AUC) analysis to predict MACE or hard MACE, defined as death, myocardial infarction, or stroke. Analyses were stratified by a history of CHD. Additional forward selection analysis was performed to evaluate incremental value of metrics. Results: Clinical characteristics were the strongest predictors of MACE in the overall cohort. In patients without history of CHD, CACS remained the only independent predictor of MACE yielding an AUC of 73 (CI 67–79) vs. 64 (CI 57–70) for clinical characteristics. Noncalcified plaque volume did not add prognostic value. Simple CHD grading schemes yielded similar risk stratification as the CAD-RADS classification. Forward selection analysis confirmed prominent role of CACS and revealed usefulness of functional testing in subgroup with known CHD. Conclusion: In patients referred for invasive angiography, a history of CHD was the strongest predictor of MACE. In patients without history of CHD, a coronary calcium score yielded at least equal risk stratification vs. more complex CHD grading.
AB - Background: The coronary atheroma burden drives major adverse cardiovascular events (MACE) in patients with suspected coronary heart disease (CHD). However, a consensus on how to grade disease burden for effective risk stratification is lacking. The purpose of this study was to compare the effectiveness of common CHD grading tools to risk stratify symptomatic patients. Methods: We analyzed the 5-year outcome of 381 prospectively enrolled patients in the CORE320 international, multicenter study using baseline clinical and cardiac computer-tomography (CT) imaging characteristics, including coronary artery calcium score (CACS), percent atheroma volume, “high-risk” plaque, disease severity grading using the CAD-RADS, and two simplified CAD staging systems. We applied Cox proportional hazard models and area under the curve (AUC) analysis to predict MACE or hard MACE, defined as death, myocardial infarction, or stroke. Analyses were stratified by a history of CHD. Additional forward selection analysis was performed to evaluate incremental value of metrics. Results: Clinical characteristics were the strongest predictors of MACE in the overall cohort. In patients without history of CHD, CACS remained the only independent predictor of MACE yielding an AUC of 73 (CI 67–79) vs. 64 (CI 57–70) for clinical characteristics. Noncalcified plaque volume did not add prognostic value. Simple CHD grading schemes yielded similar risk stratification as the CAD-RADS classification. Forward selection analysis confirmed prominent role of CACS and revealed usefulness of functional testing in subgroup with known CHD. Conclusion: In patients referred for invasive angiography, a history of CHD was the strongest predictor of MACE. In patients without history of CHD, a coronary calcium score yielded at least equal risk stratification vs. more complex CHD grading.
KW - Angina
KW - CT
KW - Coronary atherosclerosis
KW - Coronary heart disease
KW - Coronary imaging
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U2 - 10.1016/j.jcct.2023.07.004
DO - 10.1016/j.jcct.2023.07.004
M3 - Article
C2 - 37541910
AN - SCOPUS:85166628928
SN - 1934-5925
VL - 17
SP - 310
EP - 317
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 5
ER -