TY - JOUR
T1 - Coronary computed tomography plaque-based scores predict long-term cardiovascular events
AU - Lima, Thais Pinheiro
AU - Assuncao, Antonildes N.
AU - Bittencourt, Marcio Sommer
AU - Liberato, Gabriela
AU - Arbab-Zadeh, Armin
AU - Lima, Joao A.C.
AU - Rochitte, Carlos Eduardo
N1 - Funding Information:
Thaís Pinheiro Lima receveid speaker fees of Pfizer. Marcio Sommer Bittencourt received a research grant from Sanofi; speaker fees of Novartis, Novo Nordisk, EMS, and GE Healthcare; and consulting fee from Bayer. Armin Arbab-Zadeh received grant support from Canon. Joao AC Lima received grant support from Canon. Carlos E. Rochitte receveid speaker fees from Pfizer. The others authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to European Society of Radiology.
PY - 2023/8
Y1 - 2023/8
N2 - Objectives: Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD. Methods: The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3–9.1) years, and 73 patients met the composite endpoints of MACE. Results: Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SISNoncalc) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ2 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ2 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17–4.40, p < 0.001). Conclusions: Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD. Key Points: • Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD. • Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.
AB - Objectives: Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD. Methods: The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3–9.1) years, and 73 patients met the composite endpoints of MACE. Results: Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SISNoncalc) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ2 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ2 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17–4.40, p < 0.001). Conclusions: Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD. Key Points: • Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD. • Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.
KW - Computed tomography angiography
KW - Coronary artery disease
KW - Prognosis
KW - Risk factors
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U2 - 10.1007/s00330-023-09408-3
DO - 10.1007/s00330-023-09408-3
M3 - Article
C2 - 36806566
AN - SCOPUS:85148432093
SN - 0938-7994
VL - 33
SP - 5436
EP - 5445
JO - European radiology
JF - European radiology
IS - 8
ER -